March 2023

CASE HISTORY:

•A rare case of osmotic pontine demyelination due to hypokalemia in a patient with Sjogren syndrome and renal tubular acidosis.

CASE CONTRIBUTED BY

Dr. Celma Asmy S, Radiology, Manipal Hospitals, Bangalore.

 Dr. Ullas V Acharya , Radiology,  Manipal Hospitals, Bangalore.

History and Clinical Examination

First episode of hospital admission-

•h/o bilateral lower and upper limb weakness since 3 days.(past history of loose stools and vomiting 15 days back).

 LABS

•positive for SSA and Ro52 antigen.

•Hypokalemia(2.1) and Type 1 RTA. sodium –normal.

•CSF-elevated protein

•Nerve conduction studies -peripheral neuropathy

Thus a clinical suspicion of Gullain Barre syndrome was made.

Treated with IV immunoglobulins,hypokalmeia correction and steroids and was symptomatic better and discharged.

Second episode of hospital admission-

New onset of diplopia and 6th cranial nerve palsy.

O/E-Power upper limbs 5/5

lower limbs 4/5

Right lateral rectus palsy+

other extraocular movements – normal

Diagnosis

Discussion

References

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