Asymptomatic Pontine Lesion and Diabetic Amyotrophy after Rapid Improvement of Poor Glycemic Control in a Patient with Type 1 Diabetes

Yuri Shimizu; Junji Kozawa; Tomoaki Hayakawa; Yasuha Sakai; Takekazu Kimura; Tetsuhiro Kitamura; Sho Murase; Hisashi Tanaka; Norikazu Maeda; Michio Otsuki; Takaaki Matsuoka; Hideki Mochizuki; Hiromi Iwahashi; Iichiro Shimomura

doi:10.2169/internalmedicine.2835-19

CASE REPORTS

Asymptomatic Pontine Lesion and Diabetic Amyotrophy after Rapid Improvement of Poor Glycemic Control in a Patient with Type 1 Diabetes

Yuri Shimizu, Junji Kozawa, Tomoaki Hayakawa, Yasuha Sakai, Takekazu Kimura, Tetsuhiro Kitamura, Sho Murase, Hisashi Tanaka, Norikazu Maeda, Michio Otsuki, Takaaki Matsuoka, Hideki Mochizuki, Hiromi Iwahashi, Iichiro Shimomura

Author information

Yuri Shimizu
Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
Junji Kozawa
Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
Tomoaki Hayakawa
Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
Yasuha Sakai
Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
Takekazu Kimura
Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
Tetsuhiro Kitamura
Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
Sho Murase
Department of Neurology, Graduate School of Medicine, Osaka University, Japan
Hisashi Tanaka
Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, Japan
Norikazu Maeda
Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
Department of Metabolism and Atherosclerosis, Graduate School of Medicine, Osaka University, Japan
Michio Otsuki
Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
Takaaki Matsuoka
Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
Hideki Mochizuki
Department of Neurology, Graduate School of Medicine, Osaka University, Japan
Hiromi Iwahashi
Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan
Department of Diabetes Care Medicine, Graduate School of Medicine, Osaka University, Japan
Iichiro Shimomura
Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Japan

Keywords: asymptomatic pontine lesion, osmotic demyelination syndrome, magnetic resonance imaging, diabetic amyotrophy, type 1 diabetes, glycemic control

JOURNAL OPEN ACCESS

2019 Volume 58 Issue 23 Pages 3433-3439

DOI https://doi.org/10.2169/internalmedicine.2835-19

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Abstract

We herein report a 28-year-old woman with type 1 diabetes with an asymptomatic pontine lesion and diabetic amyotrophy. She had suffered from diabetes from 10 years old. Treatment in a hospital reduced the hemoglobin A1c level from 14.2% to 7.2% for approximately 2 months. She suffered from acute-onset pain and weakness of the lower limb muscles without central nervous system manifestations. Magnetic resonance imaging showed high-intensity lesions at the brainstem and lower limb muscles on T2-weighted images. These findings and symptoms gradually resolved. Rapid treatment of poor glycemic control might increase the risk of asymptomatic pontine lesions and diabetic amyotrophy.

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