A case of cerebral
salt wasting syndrome secondary to
head injury is reported here. A 4-year-old boy was admitted to our hospital with
head injury. Neurological examination revealed no abnormal findings other than consciousness disturbance. Plain skull X-ray demonstrated a linear fracture of the bilateral parietal bones, and CT scan demonstrated
subarachnoid hemorrhage of the tentorium of the cerebellum. He gradually improved, but on the 6th day deterioration of consciousness developed. At that time CT scan demonstrated no abnormal findings. Biochemical analysis showed
hyponatremia (116mEq/L) with increased natriuresis. Although a high dose of NaCl was supplied, serum
sodium levels did not normalize. So we suspected that
SIADH might be causing the
hyponatremia, and water restriction was started. He lost 1 kg in
body weight over 3 days, but serum
sodium levels remained low (118mEq/L) with increased natriuresis. We found that the
hyponatremia was caused by cerebral
salt wasting syndrome, so we treated the patient with
fludrocortisone acetate. Consciousness disturbance improved two days after the medication with
fludrocortisone acetate, and serum
sodium levels became normal (137mEq/L) on the 27th day. The administration of
fludrocortisone acetate was able to be stopped two months after admission, and then the patient was discharged without any neurological deficits. We discussed in detail the diagnosis and the treatment of cerebral
salt wasting syndrome.