Cerebral Salt Wasting due to Bilateral Hypothamic Lesions as a Presentation of NMOSD: A Case Illustration and Retrospective Review of Local Occurrence

Hyponatremia as a complication associated with neurological condition is not uncommon. Syndrome of Inappropriate Anti-Diuretic Hormone (SIADH) has been reported with (CSW increasing frequency in association with Neuromyelitis Optica Spectrum Disorder (NMOSD). Nevertheless, Cerebral Salt Wasting) is less recognized especially as the initial presentation of sero-positive NMOSD.

Objective: 1. To report a case of CSW due to bilateral hypothalamic lesions as a clinical presentation of NMOSD; 2. To review the frequency and the cause of hyponatremia in our cohort of NMOSD patients.

Methods: We illustrated a case of NMOSD presented with CSW. This was followed by a retrospective review of our Electronic Medical Records (EMR) of 86 patients with NMOSD from 2005 to 2020 who presented with persistent hyponatremia. The clinical, biochemical and radiological data were gathered and analyzed.

Results: 10/85 (11.8%) patients had persistent hyponatremia needing medical intervention. Only 3 had gastro-intestinal symptom, 5 had transverse myelitis, 1 had general malaise, and 1 had optic neuritis. One patient had new brain lesion involving the area post rema. Two patients were diagnosed as SIADH and 1 was diagnosed as CSW.

Conclusion: Even though SIADH is a more recognizable cause of hyponatremia in NMOSD, CSW need to be considered as a differential diagnosis. This case presentation highlighted the diversity in the clinical presentation of NMOSD.


Suhailah Abdullah*

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