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Neuropediatrics 2021; 52(04): 316-325
DOI: 10.1055/s-0041-1730938
Original Article

Neuroimaging Spectrum of Severe Hypernatremia in Infants with Neurological Manifestations

Sameer Vyas    *
1   Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Arushi Gahlot Saini‡   *
2   Department of Pediatric, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Amrit Kaur
2   Department of Pediatric, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Prabhjyot Singh
1   Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Muralidharan Jayashree
2   Department of Pediatric, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Venkataseshan Sundaram
3   Department of Neonatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Kanya Mukhopadhyay
3   Department of Neonatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Paramjeet Singh
1   Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
› Author Affiliations
Funding None.
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Abstract

Background Variable neurological manifestations and imaging findings have been described in children with severe hypernatremia. We aimed to describe the spectrum of neuroimaging changes in infants with severe hypernatremia.

Methods This retrospective study included infants with severe hypernatremia (serum sodium >160 mEq/L), abnormal neurological examination, and an abnormal magnetic resonance imaging (MRI) of the brain over a period of 2 years in a tertiary care hospital. Relevant clinical data, including the feeding practices, clinical features, complications, and biochemical and radiological parameters, were entered in a structured pro forma. MRI findings were classified as vascular (hemorrhages and cerebral sinus venous thrombosis), osmotic demyelination syndrome (pontine and extrapontine myelinolyses), and white matter changes.

Results The common clinical features in the neonates were poor feeding (n = 4) and decreased urine output (n = 4); the older infants presented with gastrointestinal losses (n = 5). All cases had dehydration with encephalopathy. The patterns of radiological injury were vascular (hemorrhages, n = 5 and venous thrombosis, n = 3), osmotic demyelination (n = 8), and white matter changes (n = 7). Coagulopathy was correlated with the vascular complications (r = 0.8, p < 0.0001); the degree of dehydration was correlated with the venous thrombosis (r = 0.7, p < 0.04) and acute kidney injury (r = 0.8, p < 0.001). Neurological sequelae were seen in four cases and correlated with hypernatremia (r = 0.6, p = 0.03) and hyperosmolarity (r = 0.6, p = 0.03).

Conclusion Characteristic neuroimaging findings are vascular changes in the form of venous thrombosis and hemorrhages, osmotic demyelination and white matter tract injury, and/or mostly combinations of these findings. Severe hypernatremia and resulting hyperosmolarity frequently cause neurological sequelae in neonates and infants.

Keywords

hypernatremia - demyelination - hemorrhage - venous thrombosis - neonate - infant - metabolic

Ethical Approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.


Note

For this type of study, formal consent is not required.


* These authors contributed equally to this study.




Publication History

Received: 31 December 2020

Accepted: 05 April 2021

Article published online:
30 June 2021

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