Cerebral saltwasting syndrome how is cerebral salt. Syndrome of inappropriate antidiuretic hormone siadh is frequently diagnosed in this clinical setting, but cerebral salt wasting csw is an important diagnosis to consider. Differential diagnosis between these two entities can be difficult due to considerable overlap in the laboratory findings and clinical situations. The causes and diagnosis of hyponatremia, causes and treatment of. Fludrocortisone can help in managing csw where alone. Urine sodium is usually high, though low levels have been documented in patients on low na diets, and the urine is concentrated.
Difference between siadh and cerebral salt wasting. Wijdicks ef, ropper ah, hunnicutt ej, richardson gs, nathanson ja. Cerebral salt wasting syndrome in children with acute central nervous system injury. This syndrome is often confused with dilutional hyponatremia secondary to inappropriate adh secretion. The condition typically occurs in patients who are volumedepleted. Cerebral salt wasting incidence 24% of neuro cases with hyponatremia potential pathophysiology sympathetic nervous system.
It is most seen in patients with cerebral disease, suggesting a neurologic cause. Cerebral saltwasting syndrome cerebral salt wasting syndrome. Cerebral salt wasting csw is a syndrome of hypovolemic hyponatremia caused by natriuresis and diuresis. 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. Treatment requires volume replacement and maintenance of a positive salt balance. Csw is characterized by extracellular volume depletion and presence of hyponatremia due to renal salt wasting. Atrial natriuretic factor and salt wasting after aneurysmal subarachnoid hemorrhage. The treatment of csws is always fluid and sodium resuscitation using 0.
The cerebral salt wasting syndrome is thought to be caused by the secretion of brain and atrial natriuretic hormone, which leads to a negative sodium. We describe a patient with cerebral infarction who developed cerebral salt wasting syndrome in the course of. Cerebral salt wasting syndrome csws is often an unrecognized cause of hyponatremia that occurs in the setting of intracranial lesions. 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. Electrolyte imbalances are common among patients with traumatic brain injury tbi.
Clarification of cerebral, or the more appropriate term, renal salt wasting rsw, vide infra, and its differentiation from siadh becomes critical because of. The mechanisms underlying csw have not been precisely delineated, although existing evidence strongly implicates abnormal elevations in circulating natriuretic peptides. In this manuscript, we report the case of a sixyearold patient with cerebral saltwasting syndrome associ ated with subacute sclerosing panencephalitis. Cerebral salt wasting syndrome linkedin slideshare. 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. Cerebral saltwasting syndrome medical condition youtube. Nov 28, 2015 cerebral salt wasting csw is potential cause of vna. Cerebral salt wasting syndrome definition of cerebral salt. Among various causes of hyponatremia, diagnosing syndrome of. Cerebral salt wasting syndrome in a patient with tuberculous.
We describe a patient with cerebral infarction who developed cerebral saltwasting. Cerebral salt wasting syndrome in patients with minor head trauma. A saltwasting syndrome associated with cerebral disease. Free, official information about 20 and also 2014 icd9cm diagnosis icd9cm 583. Cerebral salt wasting syndrome statpearls ncbi bookshelf. Cerebral salt wasting csw is potential cause of vna. A 34yearold woman was admitted to hospital after sustaining a head injury in a motor vehicle accident day 1. No signs of neurological deficit, skull fracture, brain contusion, or intracranial bleeding were evident. In a report of three patients, they described renal salt wasting in the setting of central nervous system 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. The term, cerebral salt wasting csw, was introduced by peters and colleagues in 1950. Nov 11, 2015 brain injury or illness, including traumatic brain injury tbi, is frequently associated with perturbations in water balance including hyponatremia. Jun 19, 2007 in such patients, hyponatremia is frequently accompanied by the syndrome of inappropriate secretion of antidiuretic hormone siadh. Sequential cerebral salt wasting complicating siadh in a.
Subarachnoid hemorrhage with cerebral salt wasting leading to cerebral ischemia. Patients present with the clinical manifestations of hyponatremia and hypovolemia. Pdf cerebral salt wasting following traumatic brain injury. Accurate diagnosis and management are mandatory for to improve the course of. Cerebral salt wasting syndrome definition of cerebral. 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. Despite this evidence, some authors have not found a direct relationship between bnp and csw.
Cerebral salt wasting syndrome is rarely seen in children. Cerebral saltwasting syndrome caused by minor head injury early hyponatraemia after pituitary surgery. Cerebral salt wasting syndrome in a patient with a. Cerebral salt wasting syndrome deranged physiology. Cerebral saltwasting syndrome in a child with wernicke. 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. The patient had developed severe hyponatremia 121 meql accompanied by signs of dehydration, intracranial. Two main pathophysiologies of hyponatremia, excluding iatrogenic causes, are inappropriate secretion of antidiuretic hormone siadh and cerebral salt wasting csw syndrome. Siadh has a greater sodium urine concentration than cerebral salt wasting. Cerebral saltwasting syndrome due to hemorrhagic brain. Cerebral salt wasting is a diagnosis of exclusion that requires a natriuresis in a patient with a contracted effective arterial. However, there are a few reports of cerebral salt wasting syndrome caused by cerebral infarction. Cerebral saltwasting syndrome clinical presentation. 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.
Cerebral saltwasting syndrome an overview sciencedirect. Cerebral saltwasting syndrome caused by minor head injury. 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. Definition cerebral saltwasting syndrome is defined by the development of extracellular volume depletion due to a renal na. The aim of this study is to report our experience with diagnosis and management of cerebral salt wasting csw in children and to evaluate the role of atrial natriuretic peptidebrain natriuretic peptide anpbnp in pediatric patients. 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 csw is another potential cause of. The key in diagnosis of csw lies in distinguishing it from the more common syndrome of. Cerebral salt wasting csw syndrome is an important cause of hyponatremia in head injuries apart from syndrome of inappropriate antidiuretic hormone siadh. 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. Cerebral saltwasting syndrome cerebral salt wasting. As such, it may be more appropriately termed renal salt wasting. Foremost among the misconceptions is the common but unproven perception that cerebral salt wasting csw is a rare clinical entity. 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.
After the description of siadh in 1957, such patients. Kinik st, kandemir n, baykan a, akalan n, yordam n 2001 fludrocortisone treatment in a child with severe cerebral salt wasting. Therefore, early diagnosis and effective treatment of hyponatremia is critical for hyponatremic patients with intracranial disease. Diagnosis and management of combined central diabetes insipidus and cerebral salt wasting syndrome after 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. Pathophysiology, diagnosis, and treatment cerebral salt wasting csw is a syndrome of hypovolemic hyponatremia caused by natriuresis and diuresis. 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 saltwasting syndrome is a disorder characterized by severe hyponatremia, volume depletion, and elevated brain natriuretic peptide but normal antidiuretic hormone levels. Diagnosis and management of cerebral salt wasting csw in.
We wanted to describe the diagnosis, treatment, and history of csw to provide clinicians with a better understanding of the differential diagnosis for. Differentiating the syndrome of inappropriate antidiuretic hormone and csw remains difficult and the pathophysiological mechanisms underlying csw are unclear. Subarachnoid hemorrhage with cerebral salt wasting leading to. Thiamine hydrochloride was administered at a dose of 100 mgday for 3 weeks. Cerebral salt wasting syndrome in a patient with a pituitary. Therefore, maintenance of volume status and sodium replacement is the mainstay of treatment in csw syndrome. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. In general, a case of very mild hyponatremia tends to. Cerebral salt wasting following traumatic brain injury. Cerebral saltwasting syndrome constitutes a medical condition characterized by hypovolemia and hyponatremia, secondary to various pathologies affecting the central nervous system cns. In general, a case of very mild hyponatremia tends to produce no noticeable. Cerebral salt wasting syndrome csws, leading to renal sodium loss is. High concentrations of sodium are found in the urine. Cerebral salt wasting syndrome in a child with sspe ios.
Csw is characterized by hyponatremia and extracellular fluid depletion due to inappropriate sodium wasting in the urine 5. What is the icd 9 code for cerebral salt wasting, jul 9. However, some authorities contend that csw does not really exist and. 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. It is important to differentiate csws from the syndrome of inappropriate adh secretion, as this would alter the management of hyponatremia. 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. 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. Although the diagnosis of cerebral saltwasting syndrome is thought to be controversial by some, it should. Introduction cerebral salt wasting syndrome csw is defined as a renal loss of sodium during intracranial disorders leading to hyponatremia and a decrease in. Treatment of cerebral salt wasting is through frequent hydration to prevent dehydration plus medications. Jan 28, 2019 cerebral salt wasting csw is another potential cause of hyponatremia in those with cns disease, particularly patients with subarachnoid hemorrhage.
The two main types of stroke are ischemic and hemorrhagic, accounting for approximately 85% and 15%, respectively 4,9,10,12,14,15. Clarification of cerebral, or the more appropriate term, renal salt wasting rsw, vide infra, and its differentiation from. The incidence and pathophysiology of hyponatraemia after subarachnoid haemorrhage. 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. For the early diagnosis of we, neuroimaging studies can be an important marker. 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.
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. Leading theories for the pathophysiology of cerebral salt wasting. Cerebral salt wasting after traumatic brain injury. If the diagnosis is csws, fluid restriction will worsen the hypovolaemic state and lead to serious complications. In this condition, the kidney is functioning normally but excreting excessive sodium. Cerebral saltwasting syndrome was subsequently diagnosed due to persistent hyponatremia, dehydrated state, and high urine sodium with massive urination. 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. Cerebral salt wasting syndrome csws is characterized by the renal loss of sodium. Cerebral salt wasting csw is another potential cause of hyponatremia in those with cns disease, particularly patients with subarachnoid hemorrhage. Cerebral salt wasting csw is an electrolyte imbalance characterized by hyponatremia and hypovolemia.