Reversible stroke-like symptoms with severe hyponatremia

A 65-year-old Caucasian female was brought to the Emergency Department by her husband for increasing generalized weakness, slurred speech and new-onset facial droop. A non-contrast computerized tomography scan of her brain was negative; however, she was found to have a sodium level of 99 mmol/L. Her daily medications included hydrochlorothiazide, omeprazole and irbesartan. On physical examination, she was found to have slight confusion, lethargy, slowed speech, generalized weakness and left-sided facial droop but no other focal deficits. Over the course of her hospital stay, the patient's sodium levels were corrected slowly On the fifth day of admission, the majority of the patient's neurologic symptoms had resolved, suggesting her stroke-like symptoms were correctable with sodium repletion.