title: Urinary incontinence a first presentation of central pontine myelinolysis: a case report.
abstract: An 84-year-old lady was treated for hyperosmolar hyperglycaemia with IV insulin, fluids and catheterisation for fluid balance monitoring. Trial without catheter failed as the patient complained of new-onset urinary incontinence and lack of awareness of bladder filling. In light of her breast cancer history, we excluded cauda equina. Ultrasound KUB showed an enlarged bladder. Whole-body MRI revealed a lesion in the pons which was highly suggestive of central pontine myelinolysis (CPM). Her electrolytes were normal throughout her admission; thus, the rapid fluctuation in osmolality, secondary to her hyperglycaemic state, was the likely cause of CPM. CPM has been reported secondary to hyperglycaemia; however, this is the first reported case of CPM presenting as urinary incontinence and loss of bladder sensation.
authors.affiliation: Ipswich Hospital NHS Trust, Ipswich, UK.
authors.forename: Asmah Hassan
authors.initials: AH
authors.lastname: Syed
authors.affiliation: Ipswich Hospital, Ipswich, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Shak
authors.affiliation: Ipswich Hospital, Ipswich, UK.
authors.forename: Ali
authors.initials: A
authors.lastname: Alsawaf
mesh_terms: D061605:Administration, Intravenous; D000369:Aged, 80 and over; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D017590:Myelinolysis, Central Pontine / Q000175:diagnosis / Q000209:etiology*; D014549:Urinary Incontinence / Q000175:diagnosis / Q000209:etiology*; D051598:Whole Body Imaging
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: central pontine myelinolysis; hyperosmolar hyperglycaemic state; older people; urinary incontinence