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Open Access Case report

Symptomatic hyponatremia following lateral medullary infarction: a case report

Jeong-Min Kim1, Kwang-Yeol Park1*, Do Hyoung Kim2, Jae-Han Bae1, Dong-Woo Shin1, Young Chul Youn1 and Oh-Sang Kwon1

Author Affiliations

1 Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea

2 Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea

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BMC Neurology 2014, 14:111  doi:10.1186/1471-2377-14-111

Published: 22 May 2014

Abstract

Background

Hyponatremia has been reported from patients with severe neurological disease, and the syndrome of inappropriate secretion of antidiuretic hormone and cerebral salt wasting syndrome are the two main etiologies of hyponatremia after brain injury. Here we describe a patient with a lateral medullary infarction who experienced symptomatic hyponatremia with finding suggestive of syndrome of inappropriate secretion of antidiuretic hormone followed by cerebral salt wasting syndrome.

Case presentation

A 70-year-old Korean man visited emergency room complaining of sudden onset vertigo and gait disturbance. Neurological exam showed left side ataxia, Horner syndrome, and right side hypesthesia. Brain magnetic resonance imaging disclosed acute infarction involving left lateral medulla. His neurological status was stabilized, but he began to complain of non-vertiginous dizziness and general weakness five days after admission. Serum sodium level dropped from 131 mEq/mL to 122 mEq/mL with reduced serum osmolarity of 265 mOsm/L. The diagnosis of syndrome of inappropriate secretion of antidiuretic hormone was made and we restricted fluid intake, but his symptoms worsened and his mental status became drowsy. Follow up serum sodium level was 108 mEq/L with volume loss, suggesting cerebral salt wasting syndrome. We treated him with hypertonic saline and his consciousness was recovered.

Conclusion

This case shows symptomatic hyponatremia after lateral medullary infarction, providing insight about distinct pathogenesis of syndrome of inappropriate secretion of antidiuretic hormone and cerebral salt wasting syndrome.

Keywords:
Hyponatremia; Syndrome of inappropriate secretion of antidiuretic hormone; Cerebral salt wasting syndrome; Lateral medulla