# March 2023

- Link: https://isnr.in/march-2023/
- Published: 2023-03-02T07:28:22+05:30
- Author: ISNR

## 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 6^(th) cranial nerve palsy.

O/E-Power upper limbs 5/5

lower limbs 4/5

Right lateral rectus palsy+

other extraocular movements – normal

| [](https://isnr.in/wp-content/uploads/2023/03/0103pic1.jpg) | [](https://isnr.in/wp-content/uploads/2023/03/0103pic2.jpg) | [](https://isnr.in/wp-content/uploads/2023/03/0103pic3.jpg) | [](https://isnr.in/wp-content/uploads/2023/03/0103pic4.jpg) | [](https://isnr.in/wp-content/uploads/2023/03/0103pic5.jpg) | 
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## Diagnosis

## Discussion

**References**