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BACKGROUND Hypernatremia is one of the most common electrolyte disturbances following aneurysmal subarachnoid hemorrhage (aSAH) and has been correlated with increased mortality in single institution studies. We investigated this association using a large nationwide healthcare database. METHODS We performed a retrospective analysis of adults between 2002 and 2011 with a primary diagnosis of aSAH using the Nationwide Inpatient Sample (NIS). Patients were grouped according to whether or not an inpatient diagnosis of hypernatremia was present. The primary outcome was the NIS-SAH outcome measure. Secondary outcomes included in-hospital mortality, length of stay (LOS), and non-routine hospital discharge. Outcomes analyses adjusted for SAH severity using the NIS-SAH Severity Score, Charlson Comorbidity Index, and the presence of cerebral edema. RESULTS A total of 18,377 patients were included in the study. The incidence of a poor outcome as defined by the NIS-SAH outcome measure was 65.9% in the hypernatremia group and 33.4% in the normonatremia group (OR=1.96, 95% CI: 1.68-2.27). There was higher mortality in the hypernatremia group (OR=1.60, 95% CI: 1.37-1.87). Patients with hypernatremia had a significantly higher rate of non-routine hospital discharge and gastrostomy. The incidences of poor outcome, in-hospital mortality, and non-routine disposition were higher in the hypernatremia group regardless of treatment type (clipping vs. endovascular embolization). Pulmonary complications and acute kidney injury were more common in the hypernatremia group as well. CONCLUSIONS In patients with aSAH, hypernatremia is associated with poorer functional outcomes regardless of SAH severity.

Primary mucinous carcinoma (PMC) is a rare adnexal neoplasm derived from sweat glands.1 To our knowledge, there has been a single case of ipsilateral and 2 cases of bilateral multifocal PMC of the eyelids reported in the literature.2, 3, 4 In both bilateral cases, the second malignant lesion was discovered following excision of the original carcinoma. We present a very rare case of multifocal PMC presenting with 3 tumors on the ipsilateral upper and lower eyelids and discuss considerations in management.