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Case 14

A case of subacute neurological decline and endocrine abnormality

A Douglas, A Baborie

Dept. Cellular Pathology, University Hospital of Wales, Cardiff, UK

This 81 year old man developed severe hyponatraemia following a left total hip replacement. His past medical history included prostate cancer under surveillance. The patient admitted to sustained weight loss, worsening shortness of breath, and lethargy. Syndrome of inappropriate ADH secretion (SIADH) was diagnosed, presumed secondary to surgery. Further investigation revealed no occult malignancy and no other cause for hyponatraemia. He was discharged when sodium levels had normalised, but had several further admissions with hyponatraemia. His final admission was for breathlessness. Imaging ruled out a pulmonary embolism. His condition continued to worsen, as he developed swallowing difficulties, weakness, and tongue fasciculations. Neurological exam showed globally decreased power. He continued to decline and the decision for best supportive care was made, and the patient passed away.


One representative TDP-43 stained section.


  • What is the most likely neurological diagnosis and how would you confirm it?
  • Is there a link between his neurological decline and hyponatraemia?