Prolonged Cerebral Salt Wasting Syndrome after Craniotomy Due to Subdural Hematoma and Intracranial Hemorrhage: A Case Report and Literature Review

Abstract

Cerebral salt wasting syndrome (CSWS) is a cause of hyponatremia in patients with brain injury, but it often improves in a short time. In this article, a patient with prolonged CSWS after craniotomy for subdural hematoma (SDH) and intracranial hemorrhage (ICH) is presented. A 73-year-old woman was transferred to the ICU due to a decreased level of consciousness (GCS= 9) with a diagnosis of SDH and ICH. The patient had a history of atrial fibrillation. The pupils were mid-sized and reactive. BP= 130/90 mm/Hg, HR=80/min, T=37.3, and initial tests were HB=12.7 gr/dl, Bun=12, Cr=0.7, Na=138 Meq/lit, K=4meq/lit, Ptt=25 Sec, INR=1.1, ESR=10. The patient was intubated 48 hours later due to a decreased level of consciousness and underwent craniotomy and hematoma drainage. From the 4th day after the operation, the patient developed hyponatremia and polyuria, but despite the administration of hypertonic sodium and normal saline, the hyponatremia persisted. On the 8th day after the operation, fludrocortisone was started, one tablet twice a day, and the patient showed a partial response to the treatment after one week, but the hyponatremia was corrected after 2 weeks. CSWS is more common and prolonged in severe and multiple brain injuries, and in these cases, the administration of fludrocortisone in addition to normal sodium and hypertonic sodium is helpful.