Cerebral salt wasting syndrome: a case report

Area of Science:

• Neurosurgery
• Endocrinology
• Nephrology

Background:

• Hyponatraemia is a common complication in neurosurgical patients, particularly after subarachnoid hemorrhage.
• Cerebral salt wasting syndrome (CSWS) is an under-recognized cause of hyponatraemia, often confused with the syndrome of inappropriate antidiuretic hormone secretion (SIADH).
• Misdiagnosis can lead to fluid restriction, exacerbating hypovolaemia and worsening neurological outcomes.

Purpose of the Study:

• To present a case illustrating the diagnostic challenges and management of CSWS in a patient with subarachnoid hemorrhage.
• To emphasize the importance of differentiating CSWS from SIADH to prevent adverse complications.
• To highlight the potential role of brain natriuretic peptide in the pathogenesis of CSWS.

Main Methods:

• Case report of a patient with subarachnoid hemorrhage presenting with hyponatraemia.
• Initial management based on a provisional diagnosis of inappropriate antidiuresis (fluid restriction).
• Subsequent diagnosis of CSWS and treatment with saline and fludrocortisone.

Main Results:

• Patient initially deteriorated with fluid restriction due to worsening hyponatraemia and hypovolaemia.
• Treatment with saline and fludrocortisone successfully reduced renal salt loss.
• Plasma sodium levels increased, and neurological status improved following appropriate management.

Conclusions:

• Cerebral salt wasting syndrome is a critical consideration in neurosurgical patients with hyponatraemia, especially post-subarachnoid hemorrhage.
• Accurate differentiation between CSWS and SIADH is essential for appropriate fluid and electrolyte management.
• Early recognition and treatment of CSWS can prevent severe complications like hypovolaemia and reduced cerebral perfusion.