- Ophthalmopathy Induced by Bilateral Carotid Cavernous Fistula in a Patient with Graves' Disease.
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Jong Kun Ha, Ji Hye Suk, A Ra Jo, Chan Woo Jung, Bong Jae Kim, Seong Oh Park, Sang Su Kim, Mi Kyung Kim
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Endocrinol Metab. 2011;26(4):335-339. Published online December 1, 2011
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DOI: https://doi.org/10.3803/EnM.2011.26.4.335
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 Abstract
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- Graves' disease (GD) can lead to specific eye afflictions including proptosis, periorbital swelling, conjunctival injection, chemosis, and opthalmoplegia, which then become a condition called Graves' ophthalmopathy or thyroid-associated ophthalmopathy (TAO). A carotid cavernous fistula (CCF) is an abnormal vascular communication between the carotid artery and the cavernous sinus. The clinical signs of CCF are very similar to TAO and should be considered as a differential diagnosis of TAO. We would like to present an interesting case of a bilateral ophthalmopathy induced by CCF in a GD patient. A 54-year-old man with a 6-year history of GD presented with bilateral exophthalmos and conjunctival injection for two months. The orbital CT scan findings were consistent with CCF, and an angiography revealed bilateral CCF. He received a bilateral coil embolization for the CCF and his ophthalmic signs were immediately improved. We recommend orbital imaging to exclude other coexisting diseases in patients who are suspected of TAO, especially when the diagnosis is uncertain or when determining whether medical or surgical intervention is appropriate.
- A Case of Central Pontine Myelinolysis in a Type 2 Diabetic Patient without Electrolyte Changes.
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A Ra Jo, Ji Hye Suk, Jong Kun Ha, Chan Woo Jung, Bong Jae Kim, Seong Oh Park, Seon Chool Hwang, Hyun Wook Choi, Mi Kyung Kim
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Endocrinol Metab. 2011;26(3):263-267. Published online September 1, 2011
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DOI: https://doi.org/10.3803/EnM.2011.26.3.263
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Abstract
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- Central pontine myelinolysis (CPM) by complicating rapid correction of severe hyponatremia has been widely reported. Additionally, CPM was occasionally reported among patients with post-liver transplantation, burns, chronic renal failure with dialysis, or other diseases associated with or not associated with other electrolyte changes or hyperosmolarity. However, there have been a few reports of CPM occurring in diabetic patients without documented electrolyte changes. This report is, to the best of our knowledge, the first report of CPM in type 2 diabetic patients without electrolyte changes in Korea. A 40-year-old man with type 2 diabetes mellitus with abruptly developed dysarthria and ataxia was admitted to our facility. He suffered from poor glucose control and multiple diabetic complications. Brain magnetic resonance imaging (MRI) revealed a well-defined bilateral symmetric hyperintense lesion in the central portion of the pons on T2- and diffusion-weighted images, which was consistent with CPM. After the patient's blood glucose and blood pressure normalized, his dysarthria and ataxia improved. Six months after discharge, follow-up MRI showed a persistent, but greatly reduced symmetric lesion in the central pons. It is certainly possible for CPM to be overlooked clinically in diabetic patients, but more cases could be diagnosed if careful attention was paid to this syndrome.
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