Involvement of bilateral posterior limb of internal capsule in hypernatraemic dehydration

Description 

A 3-month-old male infant presented with loose stools and vomiting for the past 2 weeks and altered sensorium for the past 5 days. He was being administered inadequately diluted oral rehydration solution. On examination, he had moderate encephalopathy, depressed anterior fontanel and doughy skin. Laboratory investigations showed serum sodium 200 mEq/L, potassium 6.1 mEq/L, chloride 129 mEq/L, urea 136 mg/dL and creatinine 0.7 mg/dL. MRI of the brain showed predominant involvement of bilateral posterior limbs of internal capsule and genu with diffusion restriction (figure 1A–F). The baby improved with administration of free water, supportive care and gradual reduction of serum sodium. There were no seizures, and encephalopathy improved by day 3 of hospitalisation. At 3-month follow-up, he has normal development, absence of seizures or focal motor deficits.

Figure 1

(A–F) MRI brain on day 4 of illness, axial T2 (A and D), diffusion-weighted (B and E, b...

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