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USMLE Question of the Week

A 41-year-old man is admitted to the hospital for progressive obtundation. On admission the patient’s serum sodium level is 114 mEq/L. Treatment is initiated, and seven hours later the patient’s serum sodium level is 134 mEq/L. Over the next four days the patient’s condition worsens with the development of dysarthria, dysphagia and paraparesis. What pathologic process is most likely responsible?

A. Cerebral edema
B. Diffuse axonal injury
C. Intracerebral hemorrhage
D. Osmotic demyelination
E. Uncal herniation

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