Atypical neurological manifestations associated with hyperkalemia: a case report and literature discussion

Background. Hyperkalemia is a common, potentially fatal electrolyte disorder that often occurs in the context of renal failure or as a result of pharmacological treatments. Although the best documented are cardiac manifestations, hyperkalemia can also affect the nervous and muscular systems, causing flaccid paralysis in extreme cases. Therefore, early recognition of this electrolyte imbalance is crucial to prevent severe neurological complications. Case report. An 81-year-old patient, hypertensive, diabetic, with a history of urological pathology (benign prostatic hypertrophy), on treatment with an antiplatelet agent, peripheral vasodilator, lipid-lowering agent, and aldosterone agonists, presented with bilateral lower limb motor deficit (flaccid paraparesis) that suddenly developed over 24 hours. Multiple laboratory investigations performed (extended profile biological analyses, including neuroimaging examinations, lumbar puncture) revealed significant hyperkalemia (K+ = 7.9 mEq/l). Since the only detectable cause of the neurological symptoms is the electrolyte imbalance, the therapeutic approach is modified by correcting the electrolyte disorder, initially by improving the paraparesis. However, after 10 days, the patient suddenly develops motor deficit in the left limbs, facial asymmetry, in the context of an ischemic stroke objectified on native craniocerebral tomography. This raises the issue of hyperkalemia as a possible factor in the occurrence of a cerebrovascular event associated with hyperkalemic flaccid paralysis. Conclusions. Hyperkalemia remains a significant electrolyte disorder associated with various neurological manifestations secondary to central and peripheral nervous system lesions, with therapeutic management requiring an interdisciplinary approach and careful monitoring.