Cerebral Salt-Wasting Syndrome

Oh, Man S.; Carroll, Hugh J.

doi:10.1159/000045385

Cited by 64 publications

(13 citation statements)

References 24 publications

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“…Therefore, retention of sufficient water to cause hyponatremia should be accompanied by at least a reduction in urine output and, more commonly, frank oliguria. However, some authors disagree, suggesting that substantial amounts of urine output may be maintained in patients with SIADH [3]. While this may be true during the later stages of SIADH, when natriuresis persists in an attempt to correct the fluid overload [13], we have been unable to find documentation that this occurs while the serum sodium is decreasing.…”

Section: Discussionmentioning

confidence: 70%

“…However, there are a growing number of reports describing a syndrome of hyponatremia and elevated urine sodium concentrations occurring in the setting of polyuria and hypovolemia, which has been referred to as the cerebral salt wasting syndrome (CSWS). While some authors continue to question the existence of CSWS [3], others argue that it may be more common than SIADH [4]. This disagreement is significant, as management strategies for these disorders differ and inappropriate therapy could result in unnecessary morbidity.…”

Section: Introductionmentioning

confidence: 99%

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Cerebral Salt Wasting Syndrome following Brain Injury in Three Pediatric Patients: Suggestions for Rapid Diagnosis and Therapy

Berkenbosch¹,

Lentz²,

Jimenez³

et al. 2002

Pediatr Neurosurg

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The association between hyponatremia and intracranial pathology has been well described. When accompanied by natriuresis, hyponatremia has most commonly been attributed to inappropriate secretion of antidiuretic hormone. However, there is growing evidence to suggest that many of these patients may actually have cerebrally mediated salt losses, a disorder referred to as the cerebral salt wasting syndrome (CSWS). While this syndrome has been reasonably well described in adults, data regarding CSWS in pediatric-aged patients remains sparse. Since fluid management of these disorders is different, it is important that the clinician be able to rapidly differentiate between them. We report three cases of CSWS in acutely brain-injured children and comment on the role that early quantitation of urine volume and urine sodium concentration had in rapidly establishing the correct diagnosis.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Cerebral Salt Wasting Syndrome following Brain Injury in Three Pediatric Patients: Suggestions for Rapid Diagnosis and Therapy

Berkenbosch¹,

Lentz²,

Jimenez³

et al. 2002

Pediatr Neurosurg

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“…Further isolated reports subsequently emerged, detailing the existence of CSWS in neurotrauma [2,46,47], with hyponatremia developing in association with natriuresis and evidence of volume depletion. The evidence to support a syndrome of cerebral salt wasting has not been universally accepted, however, with speculation that the diuresis and natriuresis which characterize CSWS may simply represent escape from antiduresis following SIADH [48]. Many of the studies detailing cases of CSWS rely on retrospective data; the two largest prospective studies to date to examine the etiology of hyponatremia in patients with TBI and SAH, performed by our group, did not find any evidence of CSWS [1,6].…”

Section: The Pathophysiology Of Hyponatremia In Neurosurgical Patimentioning

confidence: 99%

Neurosurgical Hyponatremia

Hannon

Thompson

2014

JCM

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Hyponatremia is a frequent electrolyte imbalance in hospital inpatients. Acute onset hyponatremia is particularly common in patients who have undergone any type of brain insult, including traumatic brain injury, subarachnoid hemorrhage and brain tumors, and is a frequent complication of intracranial procedures. Acute hyponatremia is more clinically dangerous than chronic hyponatremia, as it creates an osmotic gradient between the brain and the plasma, which promotes the movement of water from the plasma into brain cells, causing cerebral edema and neurological compromise. Unless acute hyponatremia is corrected promptly and effectively, cerebral edema may manifest through impaired consciousness level, seizures, elevated intracranial pressure, and, potentially, death due to cerebral herniation. The pathophysiology of hyponatremia in neurotrauma is multifactorial, but most cases appear to be due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Classical treatment of SIADH with fluid restriction is frequently ineffective, and in some circumstances, such as following subarachnoid hemorrhage, contraindicated. However, the recently developed vasopressin receptor antagonist class of drugs provides a very useful tool in the management of neurosurgical SIADH. In this review, we summarize the existing literature on the clinical features, causes, and management of hyponatremia in the neurosurgical patient.

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“…Distinguishing these conditions may be unexpectedly difficult [14] because they show much in common; they have overlapping clinical and biochemical signs such as absence of peripheral edema, normal renal and adrenal function, low serum Na, low serum osmolality, and high urinary Na. Glycerol and mannitol as hyperosmolar agents are commonly used for brain edema, making it difficult to assess the true urinary and plasma volume.…”

Section: Discussionmentioning

confidence: 99%

Cerebral salt-wasting syndrome due to hemorrhagic brain infarction: a case report

2014

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IntroductionCerebral salt-wasting syndrome is a condition featuring hyponatremia and dehydration caused by head injury, operation on the brain, subarachnoid hemorrhage, brain tumor and so on. However, there are a few reports of cerebral salt-wasting syndrome caused by cerebral infarction. We describe a patient with cerebral infarction who developed cerebral salt-wasting syndrome in the course of hemorrhagic transformation.Case presentationA 79-year-old Japanese woman with hypertension and arrhythmia was admitted to our hospital for mild consciousness disturbance, conjugate deviation to right, left unilateral spatial neglect and left hemiparesis. Magnetic resonance imaging revealed a broad ischemic change in right middle cerebral arterial territory. She was diagnosed as cardiogenic cerebral embolism because atrial fibrillation was detected on electrocardiogram on admission. She showed hyponatremia accompanied by polyuria complicated at the same time with the development of hemorrhagic transformation on day 14 after admission. Based on her hypovolemic hyponatremia, she was evaluated as not having syndrome of inappropriate secretion of antidiuretic hormone but cerebral salt-wasting syndrome. She fortunately recovered with proper fluid replacement and electrolyte management.ConclusionsThis is a rare case of cerebral infarction and cerebral salt-wasting syndrome in the course of hemorrhagic transformation. It may be difficult to distinguish cerebral salt-wasting syndrome from syndrome of inappropriate antidiuretic hormone, however, an accurate assessment is needed to reveal the diagnosis of cerebral salt-wasting syndrome because the recommended fluid management is opposite in the two conditions.

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Cerebral Salt-Wasting Syndrome

Cited by 64 publications

References 24 publications

Cerebral Salt Wasting Syndrome following Brain Injury in Three Pediatric Patients: Suggestions for Rapid Diagnosis and Therapy

Cerebral Salt Wasting Syndrome following Brain Injury in Three Pediatric Patients: Suggestions for Rapid Diagnosis and Therapy

Neurosurgical Hyponatremia

Cerebral salt-wasting syndrome due to hemorrhagic brain infarction: a case report

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