Hyponatremia associated with demyelinating disease of the nervous system

Abstract

A 63-year-old man was diagnosed with periodontitis and underwent tooth extraction. Several days later, he suffered a high fever, ischuria, a change in personality, and disorientation. A urologist examined him and found severe hyponatremia (117 mEq/L), and he was then transferred to our hospital. On admission, physical findings revealed dysfunction of the bladder and bowel, altered mental status, and hypovolemia. Blood chemistry showed serum sodium of 120 mEq/L, a serum urate of 1.4 mg/dL, urinary Na of 61 mEq/L, and fractional urate excretion of 16 %. Examination of the cerebrospinal fluid (CSF) showed monocytosis. Magnetic resonance imaging (MRI) of the brain and spinal cord showed multiple lesions characterized by hyperintensity on T2-weighted sequences, suggesting demyelinating disease. His sodium concentration normalized 3 days after volume replacement therapy, and his altered mental status along with the dysfunction of the bladder and bowel were promptly improved after the initiation of high-dose glucocorticoids. Additionally, the abnormal lesions on MRI markedly

An Autopsy-proven Case-based Review of Autoimmune Encephalitis

“…Hyponatremia can affect the function of the blood-brain barrier through the action of cytokines, leading to increased permeability and potentially contributing to AIE, either independently in the patient’s medical history or during treatment [ 57 , 58 ]. However, brain changes associated with hyponatremia have previously been reported in demyelinating disease, which was not observed in the current autopsy case [ 59 ]. Unfortunately, in this case, we cannot prove a direct connection between the infiltration of CD8+ T-cells and hyponatremia or the presence of the anti-LGI1 autoantibody.…”

Hyponatremia-induced worsening of trigeminal neuralgia- When the sodium plays the game

“…[ 12 ] Similarly, there are other reports of hyponatremia with pain, but the pain was either in the abdomen or lower limbs secondary to disseminated encephalomyelitis but not trigeminal neuralgia. [ 13 14 ] Sometimes, pain is noted with hyponatremia, but the definite etiology of pain may be different, like in the case of a 20-year-old girl, where it was found to be due to acute intermittent porphyria. [ 15 ] There are some studies where pain signaling has been associated with voltage-gated sodium channels.…”

A case of Acute Disseminated Encephalomyelitis with Syndrome of Inappropriate Antidiuretic Hormone Secretion

“…A case of co-existing cerebral salt wasting and ADEM was reported in 2012 [10]. In that instance, the volume status, levels of natriuretic peptide and changes in the fractional excretion of urate with sodium correction helped to differentiate between cerebral salt wasting and SIADH [10]. There were instances of encephalopathy and hyponatremia in patients with COVID-19 [11].…”