Introduction: Cerebral salt wasting is one of the causes of hypovolemia and hyponatremia seen in cranial trauma, cranial tumor or post-surgery patients. We describe a patient with traumatic subdural hematoma developing cerebral salt wasting on the 12th day of follow up.
Case presentation: A 65 year’s old drunk man is found to have felt from his balcony over 4 meters early in the morning. The initial neurological examination in emergency ward showed a coma state with no consciousness, right localizing motor response to noxious stimuli and bilateral isochoric pupils. CT (Computer tomography) scan showed broad right frontotemporal subdural hematoma. Decompressive craniectomy, hematoma drainage and duraplasty was performed, patient was admitted to our ICU (Intensive Care Unit). During ICU stay the patient didn’t show any improvement with a GCS (Glasgow Coma Scale) of 5, flexion to noxious stimuli. Patient started to show decreased turgor tonus and hypotension on the 12th day with elevated urine sodium concentration and urine osmolality, low serum uric acid levels and hyponatremia. He is diagnosed with cerebral salt wasting syndrome. Serum sodium levels and symptoms of hypovolemia recovered with proper fluid/electrolyte replacement. Though the patient is lost on the 27th day.
Conclusion: Diagnose of cerebralsalt wasting syndrome may be elusive. It may also be challenging to distinguish from inappropriate secretion of antidiuretic hormone syndrome in cranial lesions. Careful assessment leads to proper diagnosis and correct therapy for the patients.
Faruk Seçkin Yücesoy, Merve Sahingöz, Hilal Sipahioglu, Aliye Esmaoglu