Cerebral salt wasting syndrome in patients with aneurysmal subarachnoid hemorrhage.
OBJECTIVE
Hydroelectrolytic disturbances are part of the complications of subarachnoid hemorrhage. Cerebral salt wasting syndrome (CSWS) must be considered when hyponatremia is associated with a decrease in circulating volume. We performed this study to determine the clinical characteristics and management paradigm of patients with serum sodium concentration abnormalities and aneurysmatic subarachnoid hemorrhage.


METHODS
We analyzed retrospectively clinical and laboratory data from eight patients with subarachnoid hemorrhage due to rupture of an intracranial saccular aneurysm and cerebral salt wasting syndrome. Their course, as well as their clinical findings and treatment, are described.


RESULTS
In eight patients, hyponatremia that lasted for more than 24 hours was detected (serum sodium under 135 mEq/l). The sodium disturbance occurred between day 3 and day 10 in all cases, in six of them in day 7 or day 8. The specific treatment for CSWS was to increase volume delivery according to the characteristics of the patient. Except for one case, none of the remaining patients required more than 72 hours of treatment to correct hyponatremia. No treatment-related complications were found


CONCLUSIONS
Cerebral salt wasting syndrome, occurring in some patients with subarachnoid hemorrhage, is more commonly related to certain specific anatomic locations of the ruptured aneurysm, responds to sodium replacement therapy and fluids and can be diagnosed and treated based on the clinical, hydroelectrolytic and hemodynamic course of the patient. Further studies are needed to define the underlying mechanism of this condition.
Revilla-Pacheco
Francisco R
FR
Department of Neurosurgery, The American British Cowdray Medical Center, Mexico City, Mexico. frevilla@attglobal.net
Herrada-Pineda
Tenoch
T
Loyo-Varela
Mauro
M
Modiano-Esquenazi
Marcos
M
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000097:blood; D007177:Inappropriate ADH Syndrome / Q000209:etiology* / Q000378:metabolism* / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000379:methods; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood*; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000378:metabolism*; D016896:Treatment Outcome
D012964:Sodium