Transient blindness as the primary symptom of acute hyponatremia post surgery.

Hyponatremia is a common electrolyte abnormality among children and adults. Visual disturbance associated with hyponatremia has been described in the past; however, all of these cases presented primarily with other classical signs and symptoms of hyponatremia, such as seizures, gastrointestinal upset, lethargy, or headache. We present a child who developed blindness on post-operative day #6 after resection of a brain tumour. Computed tomography of the head showed no new bleed, mass lesion, edema, or occipital lobe pathology. Laboratory evaluation revealed acute hyponatremia (115 mmol/L). No other obvious symptoms of hyponatremia were present prior to its identification. As her hyponatremia was gradually corrected, her blindness completely resolved. This is the first reported patient with acute hyponatremia to present primarily with blindness; a "precondition" of chronically increased intracranial pressure (first hit) compounded by acute hyponatremia (second hit) may have induced reversible visual loss. Checking electrolytes should be the standard of care for neurosurgical patients with acute visual disturbance or other unexplained symptoms. It is a simple measure that quickly identifies a dangerous but reversible condition.

Intrathecal baclofen and pregnancy: implications for clinical care.

Pregnancy in patients with intrathecal baclofen (ITB) pumps is rare. To our knowledge, only five reported cases of pregnancy exist in the literature. Thus, there is little experience to inform health care practitioners about the maternal and fetal safety of ITB or its efficacy throughout pregnancy. There are no reports of a pregnant female with an implanted ITB pump having a spontaneous, vaginal delivery at term. As far as we know, this is the first case described in the literature. Additionally, current literature does not address clinical implications for these patients. This paper reviews literature to date and presents unique aspects of our patient. It also discusses clinical implications for treating a pregnant patient with an ITB pump. The intent of this paper is to advance our body of knowledge in caring for pregnant clients with ITB pumps and reassure families about the safety and efficacy of this treatment.