Cerebral salt-wasting syndrome in a child with Wernicke encephalopathy treated with fludrocortisone therapy: A case report.
Cerebral Salt-Wasting Syndrome (CSWS) is characterized by hyponatremia and sodium wasting in the urine. These conditions are triggered by various neurosurgical disorders such as subarachnoid hemorrhage, brain tumor, head injury, and brain surgery. To our knowledge, CSWS caused by Wernicke encephalopathy (WE) has been rarely reported.
A 2-year-old male patient presented to our hospital due to a seizure attack. He had been neglected and refused to take food for a long time (body weight < 3rd percentile). During admission, the patient showed low serum osmolality, high urine osmolality, dehydration state, increased urine output, and negative water balance, a diagnosis of CSWS was made.


METHODS
Brain MRI displayed symmetrical lesions of T2WI and FLAIR high signal intensity in the peri-aqueductal and hypothalamic areas, which suggests Wernicke encephalopathy. For the early diagnosis of WE, neuroimaging studies can be an important marker. Thiamine hydrochloride was administered at a dose of 100 mg/day for 3 weeks. Cerebral salt-wasting syndrome was subsequently diagnosed due to persistent hyponatremia, dehydrated state, and high urine sodium with massive urination.
Wernicke encephalopathy is a very rare cause of cerebral salt-wasting syndrome in pediatrics patients. The patient had a good outcome after hypertonic solution and fludrocortisone therapy.
Department of Pediatrics Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea.
Min Jeong
MJ
Han
Soon Chul
SC
Kim
Chan Uhng
CU
Joo
Sun Jun
SJ
Kim
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002675:Child, Preschool; D005438:Fludrocortisone / Q000627:therapeutic use*; D006801:Humans; D007010:Hyponatremia / Q000209:etiology*; D008297:Male; D014899:Wernicke Encephalopathy / Q000150:complications* / Q000188:drug therapy
D000893:Anti-Inflammatory Agents; D005438:Fludrocortisone