Central Diabetes Insipidus as An Unusual Sequelae of Non-Dominant Hemisphere Ischemic Stroke

Introduction: Central diabetes insipidus (CDI) is an uncommon complication of ischemic stroke and usually occurs when the hypothalamic–pituitary axis is affected. Its development following a middle cerebral artery (MCA) infarct is rare but clinically significant, as delayed recognition can lead to dehydration and hypernatremia. Objective: To present a rare case of transient CDI following a right MCA infarction and highlight the importance of early diagnosis in post-stroke patients presenting with polyuria. Material and Methods: This case was evaluated through retrospective review of hospital records. Clinical data, including neurological findings, urine output, serum sodium, serum and urine osmolality, and fluid balance, were collected. Imaging studies (CT and MRI) were reviewed to assess the infarct and exclude hypothalamic–pituitary injury. Treatment with desmopressin and the patient’s clinical response were documented. Patient confidentiality was maintained according to institutional guidelines. Results: Following a right MCA infarct, the patient developed significant polyuria and rising serum sodium. Laboratory studies confirmed CDI. Desmopressin therapy led to rapid normalization of urine output and serum sodium. The CDI was transient, resolving after short-term treatment without recurrence. Conclusion: CDI can occur as a rare complication of MCA infarction. Clinicians should consider CDI in stroke patients with unexplained polyuria, as prompt diagnosis and treatment can prevent metabolic complications and support recovery. The occurrence of CDI following a stroke, along with its complete resolution during neurological recovery, points to a vascular mechanism as the underlying cause of this condition. Take home message: Central diabetes insipidus is a rare but important complication of middle cerebral artery infarction. Early recognition of post-stroke polyuria enables timely diagnosis and desmopressin treatment, preventing hypernatremia and dehydration. Transient CDI following ischemic stroke suggests a reversible vascular mechanism.