Late-Onset Intracranial Hemorrhage Presenting as Refractory Hyponatremia: A Case Report

Young Lee; Daisuke Son; Shintaro Imaoka; Tsubasa Nakai; Minako Kamimoto; Toshihiro Hamada; Shin-Ichi Taniguchi; Masahiko Koda

doi:10.7759/cureus.38810

Late-Onset Intracranial Hemorrhage Presenting as Refractory Hyponatremia: A Case Report

Cureus. 2023 May 10;15(5):e38810. doi: 10.7759/cureus.38810. eCollection 2023 May.

Authors

Young Lee^{1

2}, Daisuke Son^{1

2}, Shintaro Imaoka^{1

2}, Tsubasa Nakai^{1

2}, Minako Kamimoto³, Toshihiro Hamada¹, Shin-Ichi Taniguchi¹, Masahiko Koda⁴

Affiliations

¹ Department of Community-Based Family Medicine, Faculty of Medicine, Tottori University, Yonago, JPN.
² Department of General Medicine, Hino Hospital, Hino-gun, JPN.
³ Tottori Medical Career Support Center, Tottori University Hospital, Yonago, JPN.
⁴ Department of Internal Medicine, Hino Hospital, Hino-gun, JPN.

Abstract

Here, we report a case of refractory hyponatremia and delayed intracranial hemorrhage following a head injury. A 70-year-old male patient was admitted with complaints of left chest pain and light-headedness after a fall. Hyponatremia recurred despite the correction with intravenous saline. Head computed tomography revealed a chronic subdural hematoma. The subsequent introduction of tolvaptan improved hyponatremia and disorientation. Delayed intracranial hemorrhage is a differential cause of refractory hyponatremia after head contusion. This case is clinically relevant because (i) the diagnostic delay of late-onset intracranial hemorrhage is common but fatal, and (ii) refractory hyponatremia can be a hint of late-onset intracranial hemorrhage.

Keywords: cerebral salt-wasting syndrome; delayed intracranial hemorrhage; head trauma; refractory hyponatremia; syndrome of inappropriate secretion of antidiuretic hormone.

Publication types

Case Reports