Cerebral salt-wasting syndrome due to hemorrhagic brain infarction: a case report

Abstract

IntroductionCerebral 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. However, there are a few reports of cerebral salt-wasting syndrome caused by cerebral infarction. We describe a patient with cerebral infarction who developed cerebral salt-wasting syndrome in the course of hemorrhagic transformation.Case presentationA 79-year-old Japanese woman with hypertension and arrhythmia was admitted to our hospital for mild consciousness disturbance, conjugate deviation to right, left unilateral spatial neglect and left hemiparesis. Magnetic resonance imaging revealed a broad ischemic change in right middle cerebral arterial territory. She was diagnosed as cardiogenic cerebral embolism because atrial fibrillation was detected on electrocardiogram on admission. She showed hyponatremia accompanied by polyuria complicated at the same time with the development of hemorrhagic transformation on day 14 after admission. Based on her hypovolemic hyponatremia, she was evaluated as not having syndrome of inappropriate secretion of antidiuretic hormone but cerebral salt-wasting syndrome. She fortunately recovered with proper fluid replacement and electrolyte management.ConclusionsThis is a rare case of cerebral infarction and cerebral salt-wasting syndrome in the course of hemorrhagic transformation. It may be difficult to distinguish cerebral salt-wasting syndrome from syndrome of inappropriate antidiuretic hormone, however, an accurate assessment is needed to reveal the diagnosis of cerebral salt-wasting syndrome because the recommended fluid management is opposite in the two conditions.

Salt Wasting Syndrome: Serial Cases

“…Hyponatremia is a common complication in central nervous system disorders, especially in cases of head injuries and cerebrovascular disorders. Dehydration is often associated with hyponatremia, which frequently occurs in the context of Cerebral Salt-Wasting Syndrome (CSWS) compared to Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) (Chaudhary et al, 2016) (Tanaka et al, 2014) (Burst, 2019). CSWS is a condition involving the disruption of sodium and water homeostasis, resulting in excessive polyuria and sodium excretion in the urine, often accompanied by hypovolemia and normal kidney function (Chaudhary et al, 2016) (Taylor et al, 2017).…”

A Case Report, Cerebral Salt Wasting Syndrome in An Adult

“…Hyponatremia is a common complication of Central Nervous System disease, especially head injury and cerebrovascular disorders, and has been considered a generalized SIADH. 6 Saleem et al, 2014 obtained approximately 67% SIADH and 33% CSW in stroke patients with hyponatremia. 7 The mechanisms underlying the association between CSW and severe neurologic disease have not been clearly identified.…”

Differential diagnosis between syndrome of inappropriate antidiuretic hormone secretion and cerebral/renal salt wasting syndrome in children over 1 year: proposal for a simple algorithm

“…Later, Cort [13] reported another similar case and named the condition as cerebral salt wasting (CSW) syndrome, because the four cases reported to date were all associated with cerebral diseases. In adults, subarachnoid hemorrhage is one of the most common CSW syndrome triggers; other causes can be represented by brain injuries, stroke, neurosurgical interventions, intracranial tumors, sepsis, and viral and bacterial meningitis [14][15][16][17].…”