Wallenberg Syndrome Complicated by Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Rare Stroke Presentation
Abstract
Girin Ray, Soumyadeep Maity, Kumar Kishlay and Mayur Bahan Mukherjee
Lateral medullary syndrome is a recognized posterior circulation stroke syndrome, but its association with syndrome of inappropriate antidiuretic hormone secretion (SIADH) is rare and may delay recognition of a reversible metabolic complication. A 78-year-old man presented with acute persistent hiccups, hoarseness, dizziness, gait imbalance, and urinary symptoms, and was found to have left lateral medullary infarction with severe euvolemic hypotonic hyponatremia consistent with SIADH. Initial conservative therapy with isotonic saline, fluid restriction, and oral salt supplementation did not adequately correct serum sodium, whereas low-dose tolvaptan produced rapid normalization with parallel clinical improvement. This case highlights the need to suspect neurogenic SIADH in brainstem stroke, especially when hyponatremia, hiccups, and autonomic dysfunction coexist.