Nov 28, 2015 cerebral salt wasting csw is potential cause of vna. Cerebral salt wasting syndrome csws cerebral saltwasting syndrome csws is a rare endocrine condition featuring a low blood sodium concentration and dehydration in response to traumainjury or the presence of tumors in or surrounding the brain. Cerebral salt wasting syndrome in patients with minor head trauma. Cerebral salt wasting csw is potential cause of vna. Leading theories for the pathophysiology of cerebral salt wasting.
If the diagnosis is csws, fluid restriction will worsen the hypovolaemic state and lead to serious complications. Pathophysiology, diagnosis, and treatment cerebral salt wasting csw is a syndrome of hypovolemic hyponatremia caused by natriuresis and diuresis. Cerebral saltwasting syndrome caused by minor head injury. First described by peters et al in 1950, cerebral saltwasting syndrome is defined by the development of extracellular volume depletion due to a renal sodium transport abnormality in patients with intracranial disease and normal adrenal and thyroid function. Despite this evidence, some authors have not found a direct relationship between bnp and csw. The patient had developed severe hyponatremia 121 meql accompanied by signs of dehydration, intracranial. However, some authorities contend that csw does not really exist and.
Cerebral saltwasting syndrome is a rare endocrine condition featuring a low blood sodium concentration and dehydration in response to traumainjury or the presence of tumors in or surrounding the. Cerebral salt wasting is a diagnosis of exclusion that requires a natriuresis in a patient with a contracted effective arterial. Cerebral saltwasting syndrome caused by minor head injury early hyponatraemia after pituitary surgery. Urine sodium is usually high, though low levels have been documented in patients on low na diets, and the urine is concentrated. Two main pathophysiologies of hyponatremia, excluding iatrogenic causes, are inappropriate secretion of antidiuretic hormone siadh and cerebral salt wasting csw syndrome. Hyponatremia develops in approximately 30% of cases as a result of either the cerebral salt wasting csw syndrome or the syndrome of inappropriate secretion of antidiuretic hormone siadh. Cerebral salt wasting csw is another potential cause of. Cerebral salt wasting syndrome definition of cerebral salt. Cerebral saltwasting syndrome csws is a rare endocrine condition featuring a low blood sodium concentration and dehydration in response to injury trauma or the presence of tumors in or surrounding the brain.
Cerebral salt wasting csw is an electrolyte imbalance characterized by hyponatremia and hypovolemia. We describe a patient with cerebral infarction who developed cerebral salt wasting syndrome in the course of. Nov 11, 2015 brain injury or illness, including traumatic brain injury tbi, is frequently associated with perturbations in water balance including hyponatremia. The key in diagnosis of csw lies in distinguishing it from the more common syndrome of. Cerebral saltwasting syndrome medical condition youtube. The incidence and pathophysiology of hyponatraemia after subarachnoid haemorrhage.
Fludrocortisone can help in managing csw where alone saline infusion does not work. In general, a case of very mild hyponatremia tends to. We describe a patient with cerebral infarction who developed cerebral saltwasting. The term, cerebral salt wasting csw, was introduced by peters and colleagues in 1950. Proper diagnosis and differentiation between these two entities are necessary for management as the treatment is quite opposite in both conditions. Subarachnoid hemorrhage with cerebral salt wasting. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Cerebral salt wasting syndrome linkedin slideshare. The condition typically occurs in patients who are volumedepleted. A saltwasting syndrome associated with cerebral disease.
Atrial natriuretic factor and salt wasting after aneurysmal subarachnoid hemorrhage. Cerebral salt wasting syndrome statpearls ncbi bookshelf. Subarachnoid hemorrhage with cerebral salt wasting leading to cerebral ischemia. Syndrome of inappropriate antidiuretic hormone siadh is frequently diagnosed in this clinical setting, but cerebral salt wasting csw is an important diagnosis to consider. However, there are a few reports of cerebral saltwasting syndrome caused by cerebral infarction.
Cerebral salt wasting syndrome following head injury in a. Cerebral salt wasting syndrome definition of cerebral. However, there are a few reports of cerebral salt wasting syndrome caused by cerebral infarction. Wijdicks ef, ropper ah, hunnicutt ej, richardson gs, nathanson ja. This form of hyponatremia is called cerebral salt wasting csw, and 30% of patients with bleeding in the area between the brain and the membranes that cover the brain subarachnoid hemorrhage develop the problem, according to author m. Cerebral salt wasting syndrome csws is a rare endocrine condition featuring a low blood sodium concentration and dehydration in response to injury trauma or the presence of tumors in or surrounding the brain. Cerebral salt wasting after traumatic brain injury. However, in rare cases, hyponatremia can be accompanied by a controversial pathology known as cerebral salt wasting syndrome csws, which is generally associated with subarachnoid hemorrhage in adults. Electrolyte imbalances are common among patients with traumatic brain injury tbi. Pdf cerebral salt wasting following traumatic brain injury. In this condition, the kidney is functioning normally but excreting excessive sodium. Treatment requires volume replacement and maintenance of a positive salt balance.
Introduction cerebral salt wasting syndrome csw is defined as a renal loss of sodium during intracranial disorders leading to hyponatremia and a decrease in. In this article, 2 patients with the cerebral salt wasting syndrome are presented. As such, it may be more appropriately termed renal salt wasting. Cerebral saltwasting syndrome clinical presentation. Cerebral saltwasting syndrome cerebral salt wasting. Cerebral saltwasting syndrome is a medical entity that leads to hyponatremia and hypovolemia due to dehydration, as a result of an acute or chronic and persistent underlying cns disorder, including trauma, tumors, and other pathologies. Specific discussions of the etiology, diagnosis, and management of cerebral salt wasting syndrome, the syndrome of inappropriate antidiuretic hormone secretion, and central diabetes insipidus are. The causes and diagnosis of hyponatremia, causes and treatment of. No signs of neurological deficit, skull fracture, brain contusion, or intracranial bleeding were evident. Therefore, early diagnosis and effective treatment of hyponatremia is critical for hyponatremic patients with intracranial disease. When hyponatremia accompanies acute brain pathology, the differential diagnosis includes fluid volume depletion, effects of certain medications, syndrome of inappropriate antidiuretic hormone siadh, and salt wasting syndromes, in particular. Fludrocortisone can help in managing csw where alone.
Cerebral salt wasting following traumatic brain injury. May 17, 2015 cerebral salt wasting syndrome is a rare endocrine condition featuring a low blood sodium concentration and dehydration in response to traumainjury or the presence of tumors in or surrounding the. After the description of siadh in 1957, such patients. In general, a case of very mild hyponatremia tends to produce no noticeable. Cerebral salt wasting syndrome csws was proposed by peters and colleagues in 1950 301 as an explanation for the natriuresis and hyponatremia that sometimes accompany intracranial disease, particularly subarachnoid hemorrhage, in which up to one third of patients often develop hyponatremia. Patients present with the clinical manifestations of hyponatremia and hypovolemia.
Clarification of cerebral, or the more appropriate term, renal salt wasting rsw, vide infra, and its differentiation from siadh becomes critical because of. Cerebral salt wasting syndrome csws is characterized by the renal loss of sodium. Clarification of cerebral, or the more appropriate term, renal salt wasting rsw, vide infra, and its differentiation from. High concentrations of sodium are found in the urine. Foremost among the misconceptions is the common but unproven perception that cerebral salt wasting csw is a rare clinical entity. What is the icd 9 code for cerebral salt wasting, jul 9. Kinik st, kandemir n, baykan a, akalan n, yordam n 2001 fludrocortisone treatment in a child with severe cerebral salt wasting. Csw is characterized by extracellular volume depletion and presence of hyponatremia due to renal salt wasting. Jun 19, 2007 in such patients, hyponatremia is frequently accompanied by the syndrome of inappropriate secretion of antidiuretic hormone siadh. Cerebral salt wasting syndrome in a patient with a.
Siadh has a greater sodium urine concentration than cerebral salt wasting. Siadh is the commonest dyselectrolytemia cause of hyponatremia following traumatic brain injury tbi whereas csw is the most elusive and challenging diagnosis of the causes of hyponatremia from intracranial causes. The treatment of csws is always fluid and sodium resuscitation using 0. Cerebral salt wasting syndrome in a patient with a pituitary. Cerebral saltwasting syndrome csws was initially described in the early 1950s as a clinical condition in patients with a cerebral lesion who had hyponatremia, and an elevated concentration of urine sodium na. Cerebral salt wasting syndrome is rarely seen in children. Differentiating the syndrome of inappropriate antidiuretic hormone and csw remains difficult and the pathophysiological mechanisms underlying csw are unclear. Cerebral saltwasting syndrome is a disorder characterized by severe hyponatremia, volume depletion, and elevated brain natriuretic peptide but normal antidiuretic hormone levels. Therefore, maintenance of volume status and sodium replacement is the mainstay of treatment in csw syndrome. In response to a nejm readers letter about a certain hyponatremia case scenario, the author of the article responded that some may choose to describe his condition as cerebral salt wasting, whereas others may prefer to call it siadh with a physiologic natriuresis caused by iatrogenic hypervolemia and that hypertonic saline will increase the. Diagnosis and management of combined central diabetes insipidus and cerebral salt wasting syndrome after traumatic brain injury. Cerebral saltwasting syndrome cerebral salt wasting syndrome. This syndrome is often confused with dilutional hyponatremia secondary to inappropriate adh secretion.
In a report of three patients, they described renal salt wasting in the setting of central nervous system disease. Cerebral 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. Csw is characterized by hyponatremia and extracellular fluid depletion due to inappropriate sodium wasting in the urine 5. Free, official information about 20 and also 2014 icd9cm diagnosis icd9cm 583. Sequential cerebral salt wasting complicating siadh in a. We wanted to describe the diagnosis, treatment, and history of csw to provide clinicians with a better understanding of the differential diagnosis for. Cerebral saltwasting syndrome an overview sciencedirect.
Cerebral salt wasting csw syndrome is an important cause of hyponatremia in head injuries apart from syndrome of inappropriate antidiuretic hormone siadh. Siadh is caused by infections and cancers while cerebral salt wasting is caused by brain trauma, injury, hematoma, and tumors all occurring in the brain. Cerebral salt wasting incidence 24% of neuro cases with hyponatremia potential pathophysiology sympathetic nervous system. Accurate diagnosis and management are mandatory for to improve the course of. Nov 27, 2014 cerebral salt wasting syndrome csws cerebral salt wasting syndrome csws is a rare endocrine condition featuring a low blood sodium concentration and dehydration in response to traumainjury or the presence of tumors in or surrounding the brain. The fluid management strategy in sah depends on myriad factors, including the status of the aneurysm secured or unsecured, and presence of vasospasm, dci, cerebral edema, cerebral salt wasting, syndrome of inappropriate antidiuretic hormone secretion siadh, and diabetes insipidus. Cerebral salt wasting syndrome csws, leading to renal sodium loss is. Jan 28, 2019 cerebral salt wasting csw is another potential cause of hyponatremia in those with cns disease, particularly patients with subarachnoid hemorrhage. Cerebral saltwasting syndrome was subsequently diagnosed due to persistent hyponatremia, dehydrated state, and high urine sodium with massive urination. Subarachnoid hemorrhage with cerebral salt wasting leading to. Cerebral salt wasting syndrome in children with acute central nervous system injury.
Among various causes of hyponatremia, diagnosing syndrome of. Cerebral salt wasting syndrome in a patient with tuberculous. Cerebral saltwasting syndrome in a child with wernicke. Cerebral saltwasting syndrome is a condition featuring hyponatremia and dehydration caused by head injury, operation on the brain, subarachnoid hemorrhage, brain tumor and so on.
Difference between siadh and cerebral salt wasting. In this manuscript, we report the case of a sixyearold patient with cerebral saltwasting syndrome associ ated with subacute sclerosing panencephalitis. Although the diagnosis of cerebral saltwasting syndrome is thought to be controversial by some, it should. Definition cerebral saltwasting syndrome is defined by the development of extracellular volume depletion due to a renal na. Cerebral salt wasting syndrome in a child with sspe ios. The two main types of stroke are ischemic and hemorrhagic, accounting for approximately 85% and 15%, respectively 4,9,10,12,14,15. The mechanisms underlying csw have not been precisely delineated, although existing evidence strongly implicates abnormal elevations in circulating natriuretic peptides. Cerebral salt wasting syndrome deranged physiology. Cerebral saltwasting syndrome due to hemorrhagic brain. A 34yearold woman was admitted to hospital after sustaining a head injury in a motor vehicle accident day 1. Cerebral salt wasting syndrome csws was initially described in the early 1950s as a clinical condition in patients with a cerebral lesion who had hyponatremia, and an elevated concentration of urine sodium na. Cerebral salt wasting syndrome csws is often an unrecognized cause of hyponatremia that occurs in the setting of intracranial lesions. It is important to differentiate csws from the syndrome of inappropriate adh secretion, as this would alter the management of hyponatremia.
Diagnosis and management of cerebral salt wasting csw in. Cerebral saltwasting syndrome constitutes a medical condition characterized by hypovolemia and hyponatremia, secondary to various pathologies affecting the central nervous system cns. For the early diagnosis of we, neuroimaging studies can be an important marker. Differential diagnosis between these two entities can be difficult due to considerable overlap in the laboratory findings and clinical situations. Apr 27, 2018 cerebral salt wasting syndrome, or renal salt wasting, may be more common than siadh and may even occur in the absence of cerebral disease.
270 482 216 683 883 1240 583 701 422 443 526 1358 801 233 1487 189 1272 789 860 299 1104 13 662 932 1425 255 139 1454 534 144 721 125 1241