Diabetes insipidus following closed head injury.

Diabetes insipidus is a rare disease and it is a very uncommon sequel of head injury. Fitz (1914) found that the incidence of the disease attributable to any cause was fourteen cases per hundred thousand admissions to a general hospital, and Rowntree (1924) found thirteen cases per hundred thousand admissions to the Mayo Clinic. Rabinowitch (1921) found one case of diabetes insipidus* among fifty thousand admissions to a general hospital. In only two of fifty-six cases reported by Rowntree(1924) and two, or possibly three, of forty-two cases reported by Jones (1944) was the diabetes insipidus due to head injury. Rand and Patterson (1937) have stressed the rarity of posttraumatic diabetes insipidus by stating that no case occurred in one hundred and fifty thousand admissions to a neurosurgical unit. Kahler (1886) reported twenty-six cases of diabetes insipidus following head injury, and Rand and Patterson (1937) recorded six cases; the majority of reports on the clinical features of the condition, however, have been based on one or two cases. Fink (1928), Turner (1928), and Warkany and Mitchell (1939) have reviewed the literature, and Riddoch (1938), Symonds (1943), and Rowbotham (1945) have recorded their impressions. It is the most common hypothalamic disorder following trauma. The injury has usually been severe and the skull fractured, the fracture generally involving the base. Thirst and polyuria begin a few days to several months after the injury. The severity of the symptoms varies from case to case, and may fluctuate in some patients. Fever sometimes improves the condition. The duration of the symptoms cannot be predicted, but inost cases do recover. The response to pituitrin therapy is usually good, but sometimes symptoms are only partly relieved and in a few cases it has no effect. Other evidence of hypothalamic injury is sometimes present, a reduction in perspiration and obesity, and disturbance in sex functions. Cranial nerves are often involved, the optic and oculo-motor being those most commonly affected.. Of all non-fatal closed head injuries (gunshot wounds and those with dural penetrations excluded,) admitted to the Military Hospital for Head Injuries, Oxford, during the years 1940-45, which numbered about five thousand, thirteen suffered from diabetes insipidus. We have had the opportunity of studying three (Cases 5, 9, -and 12) of these personally, the records of the other ten, and the records of five cases (Cases 14-18rtreated in the Nuffield Department of Surgery, Oxford, under Professor Sir Hugh Cairns. This series of eighteen cases is reviewed in an attempt to add to our present rather inadequate knowledge of the clinical features and pathology of the condition. The Table indicates the relevant features in each case.