Tubercular meningitis presenting as cerebral salt wasting syndrome in an adult: A case report

Pandit, Kamal; Pokharel, Shashwat; Kathayat, Sarita; Khanal, Sushil; Adhikari, Prabhat; Trotter, Andrew B.

doi:10.1016/j.amsu.2020.11.008

Cited by 2 publications

(1 citation statement)

References 7 publications

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“…Previously reported cases of CSW in the setting of TB meningitis initially considered SIADH as the main cause for hyponatremia, but patients did not correct with fluid restriction and 3% hypertonic saline, leading to further loss of sodium in the urine [ 13 , 14 ]. The fractional excretion of uric acid (FEUA) is also used as a marker to distinguish CSW as increased levels of FEUA persist after correction of hyponatremia by water restriction and salt supplementation [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Cerebral Salt-Wasting Syndrome in a Patient With Active Pulmonary Tuberculosis

Memon¹,

Akram²,

Popli³

et al. 2022

Cureus

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A 37-year-old female with a medical history of recently diagnosed active pulmonary tuberculosis and a new intracranial lesion presented with altered mental status, nausea, and vomiting for two days. An initial physical examination revealed that the patient was euvolemic. Laboratory findings revealed a serum sodium concentration of 105 mEq/L. During her admission, she was initially managed with lactated ringer solution in the emergency department, followed by 3% normal saline in the intensive care unit, and, eventually, on oral sodium chloride and fluid restriction on discharge. Once she was stabilized, she had episodes of dizziness, and concerns were raised about the salt-wasting syndrome.

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Section: Discussionmentioning

confidence: 99%

Cerebral Salt-Wasting Syndrome in a Patient With Active Pulmonary Tuberculosis

Memon¹,

Akram²,

Popli³

et al. 2022

Cureus

View full text Add to dashboard Cite

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Suspected medullary washout leading to severe polyuria following delayed cerebral ischemia: a case report

Sene,

Gebai,

Kopel

et al. 2023

BMC Nephrol

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Background Delayed cerebral ischemia is a clinical entity commonly encountered in patients presenting with acute neurological injury and is often complicated by dysnatremias, such as the cerebral salt wasting syndrome. In this case report, we described an exceptional case of polyuria attributed to an initial cerebral salt wasting phenomenon and iatrogenic-induced medullary washout. Case presentation A 53-year-old woman was admitted to our hospital for the management of a Modified Fisher scale grade 4 subarachnoid hemorrhage due to a ruptured posterior communicating aneurysm. She was initially managed with coil embolization and external ventricular drain due to secondary hydrocephalus. Throughout the course of her hospitalization, she developed severe polyuria reaching up to 40L per day. To keep up with the excessive urinary losses and maintain appropriate cerebral perfusion, fluid replacement therapy was adjusted every hour, reaching up to 1.3 L of crystalloid per hour in addition to aminergic support. An initial diagnosis of partial diabetes insipidus, followed by a cerebral salt wasting syndrome was suspected. While the urine output continued to increase, her serum urea concentration progressively decreased to a point of almost being undetectable on day 9. At that time, the presence of an interstitial medulla washout was hypothesized. Various pharmacological and non-pharmacological interventions were progressively introduced to regain normal renal homeostasis, including non-steroidal anti-inflammatory drugs, fludrocortisone, oral urea and high-protein intake. Medications were progressively weaned, and the patient was successfully discharged from the ICU. Conclusions Cerebral salt wasting should be considered in the initial differential diagnosis of a patient presenting with polyuria in the context of acute neurological injury. Early recognition of this entity is critical to quickly implement proper management. However, as shown in this case report, the concomitance of delayed cerebral ischemia may complexify that management.

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Tubercular meningitis presenting as cerebral salt wasting syndrome in an adult: A case report

Cited by 2 publications

References 7 publications

Cerebral Salt-Wasting Syndrome in a Patient With Active Pulmonary Tuberculosis

Cerebral Salt-Wasting Syndrome in a Patient With Active Pulmonary Tuberculosis

Suspected medullary washout leading to severe polyuria following delayed cerebral ischemia: a case report

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