OSMOTIC DEMYELINATION SYNDROME WITH KETOSIS AND WITHOUT ELECTROLYTE IMBALANCE, A RARE COMPLICATION OF JUVENILE DIABETES MELLITUS.

Abstract

Central pontine myelinolysis (CPM) is rarely reported in paediatric patients with diabetes. We report this case of a 10-year-old female with new onset diabetes. Patient presented with flaccid quadriparesis and bilateral lower motor neuron facial nerve palsy with associated history of difficulty on swallowing. MRI Brain showing central pontine myelinolysis (CPM) and bilateral parietal lobe edema. On biochemical examination blood glucose level 418mg/dl, urine ketone bodies insulin, patients condition improved. After ten days coarse of subcutaneous insulin twice a day HbA1c level was 7.1and mean plasma glucose level was 175mg/dl. MRI BRAIN shows significant improvement in CPM after 22 days compared to previous MRI scan and more improvement after 50 days with subcutaneous insulin twice a day. Though CPM is very rare with poor outcome.in our case prognosis of patient is good. And it will help us to plan a better protocol in future for CPM patient with diabetes.