Cerebral salt-wasting syndrome

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Cerebral salt-wasting syndrome
Classification and external resources
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Cerebral salt-wasting syndrome (CSWS) is a disease featuring hyponatremia (low blood sodium levels) and dehydration in response to disease processes in or surrounding the brain. This form of hyponatraemia is due to excessive renal sodium excretion resulting from a centrally mediated process and is termed cerebral salt wasting (CSW)(3).

[edit] Differential diagnosis

It may be difficult to distinguish from the syndrome of inappropriate antidiuretic hormone (SIADH), which develops under similar circumstances and also presents with hyponatremia. Patients with cerebral salt-wasting syndrome usually present with cerebral lesion/Hematoma/Tumor. They usually are dehydrated and hypovolemic. The differential would be SIADH, in which patients are usually normal to hypervolemic. The main clinical difference between these two conditions is that of total fluid status of the patient: CSWS leads to a relative or overt hypovolemia, whereas SIADH is consistent with a normal to hypervolemic patient. [1]

Another useful point in differentiating CSWS from SIADH is a laboratory finding: random urine sodium concentrations tend to be >100 mEq/L in CSWS. SIADH rarely, if ever, leads to a random urine sodium of >100 mEq/L.

[edit] Treatment

The reason for the abnormality is different, and treatments are opposites: fluid restriction is used in SIADH, which would worsen cerebral salt wasting. Instead, CSWS is treated with fluids and correction of the low sodium.

Sometimes, fludrocortisone (a mineralocorticoid) improves the hyponatremia.[2] The other way of differenting with the salt wasting syndrome is to keep the patient on water restriction and see the change in sodium.If there is a increase in sodium than it is more likely that it is SIADH than salt wasting syndrome.

[edit] References

  1. ^ Harrigan MR (1996). "Cerebral salt wasting syndrome: a review". Neurosurgery 38 (1): 152–60. doi:10.1097/00006123-199601000-00035. PMID 8747964. 
  2. ^ Betjes MG (2002). "Hyponatremia in acute brain disease: the cerebral salt wasting syndrome". Eur J Intern Med 13 (1): 9–14. doi:10.1016/S0953-6205(01)00192-3. PMID 11836078. 

(3)Cerebral salt wasting syndrome in meningoencephalitis: a case report M J Brookes and T H Gould J. Neurol. Neurosurg. Psychiatry, Feb 2003; 74: 277.

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