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
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Diagnosis
Discussion
References