A patient with right striatocapsular stroke complicated by relative adrenal insufficiency
Monday, February 4th, 2019
Introduction: Relative adrenal insufficiency can occur throughout the progression of critical illness and is generally transient.
Case: This case report describes a 74 year-old male with right hemispheric stroke syndrome on a background of multiple cardiovascular risk factors. A CT scan showed no acute change.
An MRI scan revealed an acute right striatocapsular infarction. No acute therapies (thrombolysis or endovascular clot retrieval) were performed, as the time of symptom onset was unknown (patient awoke with symptoms). One week later, hyponatraemia was noted with a concurrent decline in function. A repeat MRI showed no interval change or haemorrhagic transformation to account for the functional decline. Complications included relative adrenal insufficiency, diagnosed presumptively and managed with cortisone, and gait instability managed with rehabilitation and allied health input.
Discussion: We review the literature concerning the association between acute ischaemic stroke and adrenal insufficiency and the clinical and biochemical overlap in our patient. This case report aims to increase awareness of relative adrenal insufficiency following a stroke and provide a discussion of possible mechanisms.