We report the case of a neurosurgical patient with sustained hyponatraemia and abnormally high sodium loss in the urine, with signs of fluid volume depletion. Differential diagnosis between these two entities can be difficult due to considerable overlap in the laboratory findings and clinical situations. Syndrome of inappropriate antidiuretic hormone siadh is frequently diagnosed in this clinical setting, but cerebral salt wasting csw is an important diagnosis to consider. This case represents the first illustration of severe hyponatremia related to cerebral salt wasting syndrome caused by a minor head injury.
Ppt siadh, di, cerebral salt wasting powerpoint presentation free to. Case report article pdf available in neuro endocrinology letters 364. The syndrome of inappropriate antidiuresis and cerebral saltwasting syndrome are similar yet discrete clinical entities, the main distinction being the absence or presence of volume depletion. The primary defect in siadh is the euvolemic, inappropriate increase in plasma adh levels. Siadh has a greater sodium urine concentration than cerebral salt wasting. After you enable flash, refresh this page and the presentation should play. The two conditions may be indistinguishable at presentation, which can lead to underdiagnosis of csw in patients with cns disease.
Cerebral salt wasting following traumatic brain injury in. Siadh, diabetes insipidus, and cerebral salt wasting. Cerebral salt wasting syndrome csw is defined as a renal loss of sodium during intracranial disease leading to hyponatremia and a decrease in extracellular. Cerebral saltwasting syndrome in a child with wernicke ence. Cerebral salt wasting csw, or renal salt wasting rsw, has evolved from a misrepresentation of the syndrome of inappropriate secretion of antidiuretic hormone siadh to acceptance as a distinct entity. Siadh, di and cerebral salt wasting karim rafaat, md. Cerebral salt wasting csw is a syndrome of hypovolemic hyponatremia caused by natriuresis and. Cerebral salt wasting syndrome is rarely seen in children. Differential diagnosis between these two entities can be difficult due to considerable overlap in. While renal salt wasting is a definite clinical entity that deserves serious consideration in any nonedematous hyponatremic patient with or without cerebral disease, the contrasting therapeutic goals make it imperative to develop more effective guidelines to differentiate renal salt wasting from siadh on first encounter figure 3.
Nov 28, 2015 cerebral salt wasting csw is potential cause of vna. Cerebral saltwasting syndrome csws is a rare endocrine condition featuring a low blood sodium concentration and dehydration in response to injury trauma or the presence of tumors in or surrounding the brain. Dialysis may be needed in severe acute or chronic kidney injury. Extrarenal fluid losses l osses of nacontaining fluids as in protracted vomiting, severe diarrhea, or sequestration of fluids in a 3rd space can cause hyponatremia typically when losses are replaced by ingesting plain water or liquids low in na or by hypotonic iv fluid. Download siadh diabetes insipidus and cerebral salt wasting ppt for free. Cerebral salt wasting and siadh linkedin slideshare. Pappagenos recent brain injury, hyponatremia, and dehydration, as well as his other signs and symptoms, you suspect one of two similar central nervous system. Cerebral salt wasting incidence 24% of neuro cases with hyponatremia potential pathophysiology sympathetic nervous system. Volume for volume replacement of urine na losses when dcd from hospital, most will still need oral na supplementation for a period of time 23. Cerebral salt wasting syndrome linkedin slideshare. Ppt siadh, diabetes insipidus, and cerebral salt wasting powerpoint presentation free to download id. Avoidance of neurologic injury requires a clear understanding of why the serum sodium na concentration falls and why it rises, how the brain responds to a changing serum na concentration, and what the goals of therapy should be. Displaying powerpoint presentation on siadh diabetes insipidus and cerebral salt wasting available to view or download. Scribd is the worlds largest social reading and publishing site.
Adh adh adh is produced in cells in the supraoptic and paraventricular nuclei it is transported to and released from the posterior pituitary drain into cavernous sinus and ivc. The pathogenesis of this disorder is still not completely understood. However, some authorities contend that csw does not really exist and. A 4 to 6 meql increase in serum na concentration is sufficient to treat lifethreatening cerebral edema caused by. May, 2020 cerebral salt wasting syndrome, or renal salt wasting, may be more common than siadh and may even occur in the absence of cerebral disease. Wernicke encephalopathy is a very rare cause of cerebral salt wasting syndrome in pediatrics patients. Siadh, di, cerebral salt wasting medical specialties. Cerebral saltwasting syndrome clinical presentation. Powerpoint is the worlds most popular presentation software which can let you create professional intracranial aneurysmsanaesthesia powerpoint presentation easily and in no time. Why does the differential diagnosis of hyponatremia when it comes to these 2 conditions matter so much. Mar 14, 2014 powerpoint is the worlds most popular presentation software which can let you create professional intracranial aneurysmsanaesthesia powerpoint presentation easily and in no time. Siadh, diabetes insipidus, and cerebral salt wasting author. In this article, 2 patients with the cerebral salt wasting syndrome are presented. Ppt siadh, di, cerebral salt wasting powerpoint presentation.
Salt wasting nephropathy causing hypovolemic hyponatremia renal disorders eg, interstitial nephropathy, medullary cystic disease, polycystic kidney disease, partial urinary obstruction with low salt intake. Cerebral saltwasting syndrome is a condition featuring hyponatremia and dehydration caused by head injury, operation on the brain, subarachnoid hemorrhage, brain tumor and so on. Cerebral saltwasting syndrome due to hemorrhagic brain. Di siadh csw urine output polyuric decreased polyuric serum na high low low urine na low high high serum osm high low can be low or normal urine osm low high. It has been reported in cases with subarachnoid haemorrhage, 8 infections, 7 head injury, 9 brain tumours, 10 transsphenoidal pituitary surgery, 11 and neurosurgery. Saltwasting nephropathy causing hypovolemic hyponatremia renal disorders eg, interstitial nephropathy, medullary cystic disease, polycystic kidney disease, partial urinary obstruction with low salt intake. May, 2020 first described by peters et al in 1950, cerebral salt wasting syndrome is defined by the development of extracellular volume depletion due to a renal sodium transport abnormality in patients with intracranial disease and normal adrenal and thyroid function. Cerebral salt wasting csw is another potential cause of hyponatremia in those with cns disease, particularly patients with subarachnoid hemorrhage. However, there are a few reports of cerebral salt wasting syndrome caused by cerebral infarction. You can use these awesome ppt backgrounds for making amazing presentations related to a number of topics with the visual aid of highquality backgrounds with attractive imagery. The cerebral salt wasting syndrome is thought to be caused by the secretion of brain and atrial natriuretic hormone, which leads to a negative sodium. Hyponatremia develops in approximately 30% of cases as a result of either the cerebral salt wasting csw syndrome or the syndrome of inappropriate secretion of antidiuretic hormone siadh. Cerebral infarction and cerebral salt wasting syndrome in a patient with tuberculous meningoencephalitis southeast.
Siadh, diabetes insipidus, and cerebral salt wasting ppt presentation summary. Siadh, di, cerebral salt wasting free download as powerpoint presentation. This is a poorly understood phenomenon thought to be caused by. However, they make scant mention of cerebral salt wasting syndrome csws. Management of cerebral saltwasting syndrome centers on correction of intravascular.
Additional tests tsh high in hypothyroidism cortisol low in adrenal insufficiency, though may be inappropriately normal in infectionstressful state, therefore should get cortistim test to confirm head ct and chest xray may see evidence of cerebral salt wasting or small cell carcinoma which can both cause hyponatremia. Cerebral salt wasting csw is potential cause of vna. In siadh, the firstline intervention is fluid restriction, which will make matters worse in the volumecontracted patient with salt wasting. A 34yearold woman was admitted to hospital after sustaining a head injury in a motor vehicle accident day 1. This form of hyponatremia is called cerebral salt wasting csw, and 30% of patients with bleeding in the area between the brain and the membranes that cover the brain subarachnoid hemorrhage develop the problem, according to author m. Ever since cerebral salt wasting syndrome csw was first described in 1950, there have been debates over its existence and whether it has an important place in the differential diagnosis of hyponatraemia. Pdf cerebral salt wasting in tuberculous meningitis. Cerebral saltwasting syndrome was subsequently diagnosed due to persistent hyponatremia, dehydrated state, and high urine sodium with massive urination. Cerebral salt wasting csw is an uncommon cause of hyponatraemia and is particularly challenging to manage.
Cerebral 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. Making the diagnosis rapidly is vital as its treatment requires volume resuscitation and sodium restoration rather than the water restriction used for the more commonly observed siadh. Patients believed to have cerebral salt wasting may benefit from hypertonic saline with close monitoring hypotonic hypervolemic hyponatremia. Cerebral saltwasting syndrome caused by minor head injury. We wanted to describe the diagnosis, treatment, and history of csw to provide clinicians with a better understanding of the differential diagnosis for. Two main pathophysiologies of hyponatremia, excluding iatrogenic causes, are inappropriate secretion of antidiuretic hormone siadh and cerebral salt wasting csw syndrome. However, there are a few reports of cerebral saltwasting syndrome caused by cerebral infarction. Treatment of cerebral salt wasting is through frequent hydration to prevent dehydration plus medications. As such, it may be more appropriately termed renal salt wasting. Siadh, di, cerebral salt wasting ppt video online download. Cerebral salt wasting csw is the most elusive and challenging of the causes of hyponatraemia, and it is vital to. Cerebral salt wasting syndrome csw is defined as a renal loss of sodium during intracranial disease leading to hyponatremia and a decrease in extracellular fluid volume. Csws is characterized by renal loss of sodium resulting in polyuria, natriuresis, hyponatraemia, and hypovolaemia occurring as a result of a centrally mediated process. Siadh is caused by infections and cancers while cerebral salt wasting is caused by brain trauma, injury, hematoma, and tumors all occurring in the brain.
Definition cerebral saltwasting syndrome is defined by the development of extracellular volume depletion due to a renal na. Siadh, cerebral salt wasting presentation transcript. Ppt siadh, di and cerebral salt wasting powerpoint. Siadh syndrome of inappropriate adh secretion definition. Cerebral saltwasting syndrome, or renal salt wasting, may be more common than siadh and may even occur in the absence of cerebral disease. First described by peters et al in 1950, cerebral saltwasting syndrome is defined by the development of extracellular volume depletion due to a renal sodium transport abnormality in patients with intracranial disease and normal adrenal and thyroid function. We describe a patient with cerebral infarction who developed cerebral salt wasting syndrome in the course of. Free salt powerpoint templates provide backgrounds with images related to salt. Cerebral salt wasting syndrome csws is a rare endocrine condition featuring a low blood sodium concentration and dehydration in response to injury trauma or the presence of tumors in or surrounding the brain. If so, share your ppt presentation slides online with. Syndrome of inappropriate adh secretion definition. Challenges still confront us as we attempt to differentiate rsw from siadh, ascertain the prevalence of rsw, and address reports of rsw occurring without cerebral disease. Infusion of isotonic saline in cerebral salt wasting, since euvolemia will suppress the release of adh. Cerebral salt wasting syndrome was subsequently diagnosed due to persistent hyponatremia, dehydrated state, and high urine sodium with massive urination.
With adequate free water intake, the increase in water reabsorption induces hyponatremia, plasma hypoosmolality, and a small degree of volume expansion, which along with increased atrial natriuretic peptide levels, decrease plasma renin and aldosterone. The clinical management of hyponatraemia postgraduate. We describe a patient with cerebral infarction who developed cerebral saltwasting syndrome in the course of. Cerebral saltwasting csw, or renal saltwasting rsw, has evolved from a misrepresentation of the syndrome of inappropriate secretion of antidiuretic hormone siadh to acceptance as a distinct entity. Management of hyponatraemia in patients with acute cerebral. Siadh, diabetes insipidus, and cerebral salt wasting is the property of its rightful owner. Management of cerebral salt wasting syndrome centers on correction of intravascular. Cerebral infarction and cerebral salt wasting syndrome in a patient with tuberculous meningoencephalitis southeast asian j trop med public health, 34 2003, pp. This case represents the first illustration of severe hyponatremia related to cerebral saltwasting syndrome caused by a minor head injury. Hyponatraemia occurs in up to 10% of patients following a traumatic brain injury and is associated with a worse prognosis even in mild cases. Ppt siadh, di, cerebral salt wasting powerpoint presentation free to view id. Free download intracranial aneurysmsanaesthesia powerpoint. In this condition, the kidney is functioning normally but excreting excessive sodium.
This helps you give your presentation on intracranial aneurysmsanaesthesia in a conference, a school lecture, a business proposal, in a webinar and business and. Difference between siadh and cerebral salt wasting. In fact, serum uric acid levels in cerebral saltwasting syndrome tend to be unexpectedly low owing to a tubular transport abnormality for uric acid. Csw is characterized by hyponatremia and extracellular fluid depletion due to inappropriate sodium wasting in the urine 5. The term cerebral saltwasting syndrome is commonly used due to its significant association with the. The initiation of saline infusion supports the diagnosis of renal salt wasting and provides. Siadh, cerebral salt wasting ppt video online download. It is predominantly associated with sah and tbi but has also been described after brain tumour, ischaemic stroke, and tb meningitis. Wernicke encephalopathy is a very rare cause of cerebral saltwasting syndrome in pediatrics patients. Hyponatremia is the most frequent electrolyte disorder in critically neurological patients. Disorders of sodium balance after brain injury bja. Hyponatraemia occurs in 115% of hospital inpatients2 but is most common in the inpatient neurological population3, in whom a significant proportion of hyponatraemia is caused by csws. Cerebralrenal saltwasting syndrome is a rare condition which leads to a mildtomoderate hyponatraemia, and is commonly associated with intracranial bleeds subarachnoid haemorrhage, subdural haematomas, cerebral injury or brain tumours.
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