Severe symptomatic hyponatremia due to cerebral salt wasting syndrome in a patient with traumatic head injury and Dandy-Walker malformation of the brain

Abstract

Cerebral salt wasting (CSW) is an uncommon cause of hyponatremia characterized by extracellular volume depletion, high urine sodium concentration and osmolality, and low serum uric acid concentration in association with central nervous system (CNS) disease. Distinguishing CSW from the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), a much more common form of hyponatremia in this setting, can be challenging because both present with identical laboratory features. However, treatment of CSW and SIADH differs, making a correct diagnosis important. Here we present a case of CSW in a 75-year-old man in whom severe hyponatremia and volume depletion were discovered in the setting of traumatic head injury and Dandy-Walker malformation of the brain, a rare congenital brain malformation. Treatment with intravenous normal saline and later oral salt supplementation and fludrocortisone was successful.

Cerebral Salt Wasting Syndrome Following Right Occipital Craniotomy in a Patient With Metastatic Lung Adenocarcinoma

“…Serum uric acid is another marker that can help diagnose CSW. It is elevated as it is a prerenal cause of hyponatremia with hypovolemia [11]. In our patient, the serum uric acid level was recorded at 8.4 mg/dL, confirming that her etiology of hyponatremia was indeed due to CSW.…”

Hyponatremia in Young Patients with Pulmonary Tuberculosis and Tuberculous Meningoencephalitis

“…Hyponatremia can arise from two factors: Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) and Cerebral Salt Wasting (CSW) (Yoshida et al, 2022). SIADH occurs when the normal secretion of AVP (antidiuretic hormone) is disrupted due to hypothalamic or pituitary gland injury or dysfunction (Wilke, 2021), while CSW is characterized by hypovolemia and negative salt balance (Liangos & Madias, 2021). The utilization of Fractional excretion of Uric Acid and the fractional excretion of phosphate has consistently proven to be effective in distinguishing between SIADH and CSW (Rudolph & Gantioque, 2018).…”