Cerebral Salt-Wasting Syndrome and Elevated Brain Natriuretic Peptide Levels caused by Minor Traumatic Brain Injury: A case report

• Main Authors: Dinh Thi Phuong Hoai, Bui Long The, Tran Thi Mai Dieu, Le Nha Duyen, Mai Dang Thi, Nguyen Thanh Minh
• Format: Article
• Language: English
• Published: KeAi Communications Co., Ltd. 2020-09-01
• Series: Brain Hemorrhages
• Subjects: Cerebral salt wasting syndrome; Elevated brain natriuretic peptide; Hypovolemic hyponatremia; Minor traumatic brain injury
• Online Access: http://www.sciencedirect.com/science/article/pii/S2589238X20300449

Instruction: Hyponatremia can be caused by various conditions such as Cerebral Salt Wasting Syndrome (CSWS), Inadequate Antidiuretic Hormone Secretion (SIADH), secondary adrenal dysfunction and thyroid dysfunction. However, each diagnosis has different treatment and inadequate treatment may increase mortality and morbidity, especially CSWS and SIADH. To the best of our knowledge, this case is considered rare clinical scenario and we would summarize some diagnostic criteria for these two diseases in this case report. Case presentation: A 44-year-old Asian man was presented with cerebral salt wasting syndrome and elevated brain natriuretic peptide (BNP) after 2 weeks of a mild traumatic brain injury. Central nervous system examination revealed GCS 14 without neurological or neurosurgical deficit as well as cardiovascular history. CT scan showed right temporal hemorrhage #1.4 × 1.5 cm, scattered subarachnoid hemorrhages in the right hemisphere. The patient was treated in the direction of CSWS and symptoms of hyponatremia improved after 7 days. Re-examination after 3 months did not show any abnormal symptoms, sodium serum level returned to normal. Conclusion: Hyponatremia caused by CSWS may occur in mild traumatic brain injury. Therefore, an accurate diagnosis and proper differentiation from SIADH is necessary to obtain an appropriate treatment with fluid and salt replacement. In this way, the patient morbidity and mortality can be reduced significantly.