Photo Credit: Sopone Nawoot

The following is a summary of “Hyponatremia is associated with malignant brain edema after mechanical thrombectomy in acute ischemic stroke,” published in the January 2025 issue of Neurology by Qian et al. 

Hyponatremia (<135 mmol/L) is common in patients with stroke. Few studies explore its relationship with outcomes in acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT). 

Researchers conducted a retrospective study to explore the association between hyponatremia and clinical outcomes following MT. 

They conducted a retrospective study at our center. Primary outcomes were postoperative malignant brain edema (MBE), 90-day mortality, and adverse function (modified Rankin scale scores of 6 and >2). Patients were grouped by serum sodium levels at admission. MBE was assessed by CT post-MT, and 90-day outcomes were obtained via interviews or phone. Multivariate analysis explored associations with hyponatremia. 

The results showed that 342 patients were enrolled, with 52 (15.2%) having hyponatremia, 86 (25.1%) developing postoperative MBE, 93 (27.2%) dying within 90 days, and 201 (58.8%) having an adverse function at follow-up. Multivariate analysis showed hyponatremia was significantly associated with postoperative MBE (OR 3.91, 95% CI 1.66-9.23, P=0.002), 90-day mortality (OR 5.49, 95% CI 2.48-12.14, P<0.001), and 90-day adverse function (OR 3.25, 95% CI 1.29-8.12, P=0.012). Mediation analysis showed postoperative MBE partially accounted for 90-day mortality/adverse function (regression coefficients changed by 18.6% and 23.9%, respectively). 

Investigators found hyponatremia predicted postoperative MBE, 90-day mortality, and adverse function. Correcting hyponatremia may have improved prognosis. 

Source: bmcneurol.biomedcentral.com/articles/10.1186/s12883-025-04051-5