Dural Sinus Thrombosis with Severe Hypernatremia Developing in a Patient on Long-Term Lithium Therapy

Abstract

Dural sinus thrombosis has not been described in a patient with hypernatremia resulting from lithium-induced nephrogenic diabetes insipidus. A 63-year-old man on chronic lithium therapy for schizoaffective disorder was transferred to the Emergency Department with dehydration and signs of central nervous system dysfunction after a 3-week isolation in a room in a psychiatric hospital due to exacerbation of psychiatric disorder, during which he refused to eat. Laboratory examination revealed hypertonic hypernatremia (osmolality, 359 mOsm/kg and Na, 171 mEq/L) and hyposthenuria (specific gravity, 1.010 and osmolality, 249 mOsm/kg), with normal serum endogenous vasopressin concentration (2.3 pg/mL). The serum lithium concentration was within the therapeutic range (0.94 mEq/L). Cranial computed tomography demonstrated subarachnoid hemorrhage and suggested dural sinus thrombosis. Although treatment with indomethacin (25 mg parenterally at 8-hour intervals) was somewhat effective in restoring renal concentrating capacity, he died of massive hemorrhagic infarction on the sixth hospital day, probably secondary to dural sinus thrombosis. The clinical diagnosis was confirmed by postmortem examination. Physicians should be alert for the possibility of dural sinus thrombosis as a complication of hypernatremia resulting from lithium-induced nephrogenic diabetes insipidus.

Cerebral Venous Thrombosis: Analysis of a Multicenter Cohort From the United States

“…This association has been previously reported. [13][14][15] A comparison of therapeutic modalities was not feasible in this series because of the retrospective and nonrandomized study design. Several authors have advocated thrombolytic therapy.…”

Deep Vein Thrombosis after Lithium Toxicity: A Report of Two Cases and Literature Review

“…Although we identified DVTs after lithium toxicity, thrombosis has also been reported in patients with normal lithium concentrations. Kamijo et al [8] reported dural sinus 2…”

“…Wasay et al [ 7 ] reported superior sagittal sinus thrombosis associated with lithium-induced nephrogenic diabetes insipidus. Kamijo et al [ 8 ] reported a patient with dural sinus thrombosis and severe hypernatremia that had developed after long-term lithium therapy. DVTs associated with lithium toxicity have also been reported [ 9 ].…”

A Case of Central Diabetes Insipidus in a Female Patient with Bipolar Disorder, Lithium Consumer Over the Last Years

“…We have found few cases documented and the mechanism of action is not known. In all references found the population studies are people with lithium treatment who develop symptoms of diabetes insipidus by the simultaneous presence of other pathologies: trauma (Olson, 2004), aortic stenosis (Hensen, 1997), cavernous sinus thrombosis (Kamijo, 2003). The role of lithium in the regulation of ADH release is discussed due to its participation in osmolarity and its action on osmoreceptors as controllers of ADH release (Gold, 1983 In our case it is appropriate to note the existence of viral encephalitis in the appearance of the picture, so it is worth recalling the pathological images of sella and pituitary findings.…”