Burdenko Neurosurgical Center, Moscow, Russia.
Research Institute of Emergency Pediatric Surgery and Traumatology, Moscow, Russia.
Zh Vopr Neirokhir Im N N Burdenko. 2022;86(5):112-118. doi: 10.17116/neiro202286051112.
The authors report permanent central diabetes insipidus (CDI) in a patient after severe traumatic brain injury (TBI) in traffic accident. A 16-year-old boy entered to a medical facility in coma (GCS score 6) with the following diagnosis: acute TBI, severe cerebral contusion, subarachnoid hemorrhage, depressed comminuted cranial vault fracture, basilar skull fracture, visceral contusion. CDI was diagnosed in 3 days after injury considering polyuria and hypernatremia (155 mmol/l). Desmopressin therapy was initiated through a feeding tube. Thirst appeared when a patient came out of the coma after 21 days despite ongoing desmopressin therapy. Considering persistent thirst and polyuria, we continued desmopressin therapy in a spray form. Under this therapy, polyuria reduced to 3-3.5 liters per a day. Symptoms of CDI persisted in long-term period (2 years after TBI) while function of adenohypophysis was intact. This case demonstrates a rare development of permanent diabetes insipidus after TBI. CDI manifested only as polyuria and hypernatremia in coma. Thirst joined after recovery of consciousness. Probable causes of CDI were damage to neurohypophysis and partially injury of pituitary stalk because of extended basilar skull fracture and/or irreversible secondary lesion of hypothalamus following diffuse axonal damage after TBI.
作者报告了一例交通事故中严重创伤性脑损伤（TBI）后患者发生永久性中枢性尿崩症（CDI）。一名 16 岁男孩因昏迷（GCS 评分为 6）被送入医疗机构，诊断为：急性 TBI、严重脑挫裂伤、蛛网膜下腔出血、凹陷性粉碎性颅盖骨折、颅底骨折、内脏挫裂伤。在受伤后 3 天，由于多尿和高钠血症（155mmol/L），诊断为 CDI。通过喂养管开始使用去氨加压素治疗。在 21 天后，尽管持续使用去氨加压素治疗，患者从昏迷中苏醒后出现口渴。考虑到持续的口渴和多尿，我们继续以喷雾形式使用去氨加压素治疗。在这种治疗下，多尿减少到每天 3-3.5 升。在 TBI 后长达 2 年的长期期间，CDI 症状持续存在，而腺垂体功能完好。该病例表明 TBI 后罕见发生永久性尿崩症。CDI 在昏迷时仅表现为多尿和高钠血症。在意识恢复后出现口渴。CDI 的可能原因是由于广泛的颅底骨折和/或弥漫性轴索损伤后下丘脑的不可逆继发性损伤，导致神经垂体和垂体柄损伤。
