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Central nervous system lesions
Published in Ibrahim Natalwala, Ammar Natalwala, E Glucksman, MCQs in Neurology and Neurosurgery for Medical Students, 2022
Ibrahim Natalwala, Ammar Natalwala, E Glucksman
The frequency of seizures following SAH has been reported to be between 6% and 18%. Routine use of anticonvulsants following SAH has not been proven useful. Hyponatraemia has a reported incidence of 10%—30% following SAH. It is important to determine the cause of this. It may be a result of syndrome of inappropriate antidiuretic hormone secretion (SIADH), cerebral salt wasting, or it may be caused by other systemic disease or iatrogenic fluid administration. The differential is important because the treatment for each is different. SIADH is treated by fluid restriction whereas cerebral salt wasting is treated with hydration, sodium replacement and sometimes fludrocortisone.4,5
Low-grade Glioma Presenting in the Optic Pathways and Hypothalamus
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Peter M.K. de Blank, Ian Simmons, Astrid Sehested, Michael J. Fisher
The most common endocrinopathies observed include growth hormone deficiency and precocious puberty, although numerous endocrine disorders have been reported.39,44,45 Deficiencies of thyroid and cortisol production may rarely be seen but are more frequent as sequelae to treatment with radiotherapy or surgery. The latter may also precipitate diabetes insipidus, which is otherwise almost never seen with these tumors. Persistent cerebral salt wasting has also been described as a sequela of these tumors.156 Risk of dysfunction is greater among tumors involving the hypothalamus (modified Dodge H+) than those affecting the chiasm and nerves (modified Dodge 1 and 2).92,154,155 Treatment with radiation also significantly increases the risk of endocrinopathies,96,155 particularly growth hormone deficiency,44 although endocrine disorders are also common in patients treated without surgery or radiation.154 Children with NF1-OPHG appear to be at equal risk of endocrine disorders as those with sporadic tumors,44 although not all studies agree.155
Traumatic brain injury
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Electrolyte imbalance is common in TBI, and contributes to brain swelling and to causing seizures. Diverse mechanisms are involved. Cerebral salt wasting, a poorly understood form of excretory dysregulation in association with brain insult, leads to volume depletion and hyponatraemia. The syndrome of inappropriate antidiuretic hormone (SIADH) leads to a water retention and hyponatraemia in the context of pituitary damage. This is of particular concern in head injury since low serum osmotic pressure can contribute to brain swelling, so hypotonic fluids are avoided in this setting. Conversely, ADH secretion may be compromised in the context of trauma, producing diabetes insipidus resulting in hypernatraemia.
Approach to and management of abnormalities in plasma sodium
Published in Acta Clinica Belgica, 2019
Salt depletion could be of renal origin: in Addison’s disease, combined mineralo-corticoid deficiency (which causes renal sodium wasting and hyperkalemia) and glucocorticoid deficiency (which enhances AVP secretion) contribute to high AVP concentration. In hyponatremia-related to the ‘cerebral salt wasting’ (CSW) syndrome, natriuresis is believed to precede water retention (natriuresis follows water retention in classical SIADH). This syndrome has been reported with different brain diseases and particularly with subarachnoid hemorrhage (SAH) in which up to one third of patients develop hyponatremia. It has been shown that despite large volumes of isotonic saline infusion hyponatremia developed in 32% of patients with SAH in association with non-suppressed plasma AVP levels [14]; the high AVP concentration was therefore not secondary to volume depletion. It seems likely that SAH represents a mixed disorder in which some patients have both exaggerated natriuresis and uricosuria, related to secretion of natriuretic factors and inappropriate AVP secretion [14].
Strategies for the diagnosis and management of meningitis in HIV-infected adults in resource limited settings
Published in Expert Opinion on Pharmacotherapy, 2021
Marise Bremer, Yakub E Kadernani, Sean Wasserman, Robert J Wilkinson, Angharad G Davis
Hyponatremia presents in 44% of TM cases, with cerebral salt wasting syndrome more frequently the underlying cause and relating to severity of the condition, than the syndrome of inappropriate secretion of antidiuretic hormone [151]. Distinction between these two causes is critical and clinical estimation of intravascular fluid volume can guide the diagnosis [152]. Fever in TBM increases 1 year mortality, but aggressive temperature control still requires further investigation [153].