Hyponatremic Encephalopathy after Excessive Water Ingestion Prior to Pelvic Ultrasound: Neuroimaging Findings

Gul Yalcin-Cakmakli; Kader Karli Oguz; Ali Shorbagi; Demet Funda Bas; Begum Ergan-Arsava; Mahir Kunt; Mehmet Akif Topcuoglu

doi:10.2169/internalmedicine.49.3395

CASE REPORTS

Hyponatremic Encephalopathy after Excessive Water Ingestion Prior to Pelvic Ultrasound: Neuroimaging Findings

Gul Yalcin-Cakmakli, Kader Karli Oguz, Ali Shorbagi, Demet Funda Bas, Begum Ergan-Arsava, Mahir Kunt, Mehmet Akif Topcuoglu

Author information

Keywords: water intoxication, acute hyponatremia, seizure, encephalopathy, serum inappropriate ADH syndrome, magnetic resonance imaging, diffusion-weighted imaging

JOURNAL OPEN ACCESS

2010 Volume 49 Issue 16 Pages 1807-1811

DOI https://doi.org/10.2169/internalmedicine.49.3395

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Abstract

We report two patients with acute hyponatremic encephalopathy which developed after massive water ingestion for pelvic ultrasound and emphasize the findings of magnetic resonance (MR) imaging including diffusion-weighted imaging (DWI). Both subjects had completely recovered within 24 hours following fluid restriction and salt replacement. MR imaging revealed cortical sulcal narrowing, restricted diffusion and sulcal T2 hyperintensity along with diffuse pial enhancement suggesting diffuse cerebral cortical cytotoxic edema and blood-brain barrier breakdown. In addition to the first illustration of multimodality MR imaging features of water-intoxication, these two cases also highlight the need for standardized practice on the quantity of water intake recommended to distend the bladder for pelvic ultrasound, especially in patients at risk for serum inappropriate ADH syndrome-related hyponatremia.

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