A case of reversible disturbance of consciousness following leptomeningeal metastases
10.2512/jspm.9.528
- VernacularTitle:髄膜播種を契機に下垂体機能の障害に伴う低ナトリウム血症を発症し，可逆性の意識障害を呈した1例
- Author:
Kazuki Shimada
;
Syo Goya
;
Teppei Tsumori
;
Mika Saijyo
;
Taizo Higami
;
Eriko Tani
;
Sawa Takeoka
;
Kanako Kurata
;
Ayako Tanaka
;
Masanari Hamaguchi
;
Motohiro Tamiya
;
Takayuki Shiroyama
;
Naoko Morishita
;
Norio Okamoto
;
Hidekazu Suzuki
;
Tomonori Hirashima
;
Ichiro Kawase
- Publication Type:Journal Article
- Keywords:
disturbance of consciousness;
hyponatremia;
hypopituitarism;
leptomeningeal metastasis;
end-stage cancer
- From:Palliative Care Research
2014;9(4):528-532
- CountryJapan
- Language:Japanese
-
Abstract:
Introduction：Hyponatremia, which is frequently present in patients with end-stage cancer, causes delirium and disturbance of consciousness and is considered a poor prognostic factor. We report a case of hyponatremia with hypopituitarism in association with leptomeningeal metastasis, resulting in reversible disturbance of consciousness. Case report：A 77 year-old female received chemotherapy at our hospital for postoperative recurrence of lung cancer, and best supportive care due to a side effect. After transfer to another hospital, she experienced a sudden disturbance of consciousness and was returned to our hospital. A detailed examination resulted in a diagnosis of hyponatremia from hypopituitarism following leptomeningeal metastasis involving the cerebral ventricles. Hyponatremia was improved by NaCl supplement and hormone replacement, followed by recovery from disturbance of consciousness. Discussion：QOL of patients with end-stage cancer can be improved through the active treatment of reversible causes of disturbance of consciousness. Conclusion：When severe hyponatremia is detected in cancer patients, it is important to consider the possibility of hypopituitarism with brain metastasis or meninges dissemination in the differential diagnosis.
