Title:
Cerebral Salt Wasting Syndrome in an Elderly Patient with Cerebral Small Vessel Disease

Authors:
Leslie Bahn Kawa, Kulsoom Fatima Bhatti, UK

Abstract:

Background: Cerebral salt wasting syndrome is reported in neurosurgical literature from traumatic and non-traumatic brain injuries. No cases have been reported in the medical literature secondary to cerebral small vessel disease.

Introduction: Hyponatremia is a common electrolyte disturbance seen among the acute geriatric admissions with two common diagnostic entities; the secretion of inappropriate antidiuretic hormone (SIADH) and cerebral salt wasting syndrome (CSWS) that have different clinical and biochemical presentations, different pathogenesis and therapeutic approaches.

Hyponatremia caused by CSWS in patients with cerebral small vessel disease (cSVD)- a prevalent condition among the elderly, can be masked in geriatric patients with concomitant fluctuating neurological deficits. Correct diagnosis is crucial to appropriate management.

In this case report we describe an association between hyponatremia caused by CSWS in a patient with cSVD.

Case description: A 79-year-old female with a history of chronic fluctuating confusion and apraxia with declining memory over a year. She presents with another acute fluctuating confusion, apraxia, and moderate hyponatremia detected as an incidental finding. Her biochemistry simulates syndrome of inappropriate antidiuretic hormone secretion. Additionally, her urinary sodium was significantly elevated. Treatment with fluid restriction worsened her hyponatremia but improved on saline infusion. There were no other causes of hyponatremia. Her computer tomography head shows moderate cerebral small vessel disease. 

Conclusion: Cerebral salt wasting syndrome is rare in medical admissions as a cause of hyponatremia and remains a diagnosis of exclusion. Cerebral small vessel disease and hyponatremia are common abnormalities among acutely ill geriatric patients. Hyponatremia with significant urinary sodium excretion with a combination of a chronic history of fluctuating neurological deficits with clinical findings and brain imaging suggesting cerebral small vessel disease suggests cSVD as the aetiology of cerebral salt wasting syndrome. 

A combination of chronic history of fluctuating neurological deficits hyponatremia with significant urinary sodium excretion and clinical findings and brain imaging suggesting cerebral small vessel disease can be suggest the aetiology of cerebral salt wasting syndrome.

DOI: http://dx.doi.org/10.51505/ijmshr.2024.8401