Cerebral salt-wasting syndrome due to hemorrhagic brain infarction: a case reportReport as inadecuate




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Journal of Medical Case Reports

, 8:259

First Online: 23 July 2014Received: 03 April 2014Accepted: 16 May 2014DOI: 10.1186-1752-1947-8-259

Cite this article as: Tanaka, T., Uno, H., Miyashita, K. et al. J Med Case Reports 2014 8: 259. doi:10.1186-1752-1947-8-259

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.

KeywordsCerebral salt-wasting syndrome Hemorrhagic brain infarction Hyponatremia AbbreviationsANPAtrial natriuretic peptides

BNPBrain natriuretic peptides

BUNBlood urea nitrogen

CNSCentral nervous system

CSWSCerebral salt-wasting syndrome

CTComputed tomography

FEUAFractional excretion of uric acid

IVCInferior vena cava

MRAMagnetic resonance arteriography

NaSodium

SIADHSyndrome of inappropriate secretion of antidiuretic hormone.

Electronic supplementary materialThe online version of this article doi:10.1186-1752-1947-8-259 contains supplementary material, which is available to authorized users.

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Author: Tomotaka Tanaka - Hisakazu Uno - Kotaro Miyashita - Kazuyuki Nagatsuka

Source: https://link.springer.com/







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