Karlsson A-K, Krassioukov A V
Spinal Cord Injury Unit, Institution of Clinical Neuroscience, Sahlgrenska Academy, Göteborg, Sweden.
Spinal Cord. 2004 Mar;42(3):204-7. doi: 10.1038/sj.sc.3101577.
Case report and literature review.
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.
Spinal Cord Injury Unit in Göteborg, Sweden.
Retrospective analysis of clinical charts of an individual with traumatic spinal cord injury.
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.
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.
病例报告及文献综述。
报告一例急性颈髓损伤合并视力障碍的长期低钠血症罕见病例，并就该问题回顾相关文献。
瑞典哥德堡脊髓损伤病房。
对一名创伤性脊髓损伤患者的临床病历进行回顾性分析。
一名既往健康的28岁男性在机动车事故中发生C7损伤。其损伤接受了手术治疗，在急性治疗期及术后存在补液过量情况。当脱机时，他出现意识模糊、焦虑，血清钠（S-Na）为127 mmol/L，并主诉视力障碍。低钠血症通过补充额外的钠及限制液体摄入进行治疗，但血清钠降至最低值121 mmol/L（伤后第14天）。右眼视力为0.2，左眼视力为0.06，眼部检查发现眼底高压体征。CT扫描和MRI未显示脑水肿迹象。患者进一步接受盐皮质激素及限制液体摄入治疗4个月，其视力稍有改善，但在伤后125天的最终检查中，发现其左眼存在传入性瞳孔缺陷及双侧视神经萎缩。低钠血症得到缓解，伤后6个月其血清钠恢复正常。
脊髓损伤患者发生低钠血症的风险增加。所报告的视力障碍并发症进一步强调了在这类患者中预防补液过量及及时处理低钠血症的重要性。
