Abstract
Study design: Case report and literature review.
Objective: To report an unusual case of prolonged hyponatremia in acute cervical spinal cord injury complicated by visual disturbances and to review the literature regarding the issue.
Settings: Spinal Cord Injury Unit in Göteborg, Sweden.
Methods: Retrospective analysis of clinical charts of an individual with traumatic spinal cord injury.
Results: A previously healthy 28-year-old man sustained a C7 injury in a motor vehicle accident. His injury was managed surgically and he was overhydrated during the acute management and postoperatively. When weaned off the respirator he was confused and anxious and showed a S-Na of 127 mmol/1 and complained of visual disturbances. The hyponatremia was treated by extra sodium and fluid restriction but fell to a lowest value of 121 mmol/l (Day 14 post injury). Visual acuity was 0.2 on right eye and 0.06 on left eye and the eye examination revealed signs of fundus hypertonicus. CT scans and MRI revealed no signs of brain edema. The patient was further treated by mineral corticoids and fluid restriction for 4 months and his vision improved slightly, but on a final examination 125 days post injury he was found to have an afferent pupillary defect on his left eye, and bilateral atrophy of the visual nerves. The hyponatremia resolved and 6 months post injury he showed a normal S-Na.
Conclusions: SCI individuals are at increased risk of developing hyponatremia. The reported complication of visual disturbances further stresses the importance of prevention of overhydration and of timely management of hyponatremia in this group of patients.
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Acknowledgements
We are thankful to Dr E McLachlan, and Dr W Jänig, organizers of the Satellite symposium ‘Autonomic dysfunction in spinal cord injury’, Sydney, Australia for the possibility to start fruitful collaborations between our research teams. Ann-Katrin Karlsson is supported by grant from the Swedish Medical Society (2001-671) and Andrei Krassioukov is supported by Christopher Reeve Paralysis Foundation Grant (KB2-0003-1) and a grant from the Heart and Stroke Foundation of Ontario (NA4951).
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Karlsson, AK., Krassioukov, A. Hyponatremia-induced transient visual disturbances in acute spinal cord injury. Spinal Cord 42, 204–207 (2004). https://doi.org/10.1038/sj.sc.3101577
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DOI: https://doi.org/10.1038/sj.sc.3101577
