Türk Nöroşirürji Dergisi 1999 , Vol 9 , Num 3
Saim KAZAN, Mahmut AKYÜZ, Recai TUNCER
Akdeniz Üniversitesi Tıp Fakültesi, Nöroşirürji Anabilim Dalı, Antalya Hyponatremia is frequently associated with intracranial pathologies and is also caused to the worsening of the patients' neurologic condition. This condition has often been linked to the syndrome of inappropriate secretion of antidüiretic hormone (SIADH). However, the demonstration of volume depletion and natriuresis in some patients has suggested that cerebral salt wasting (CSW) is a more likely etiology. To investigate the volume status of patients with symptomatic hyponatremia following intracranial operation, we monitorised 15 patients that their central venous pressures (CVP) measured via the subclavian vein catheter. The treatment was performed according to measurements of CVP and the severity of hyponatremia. Five patients were hypovolemic (CVP < 6 cmH2O), eight patients were normovolemic (CVP - 6 -10 cmH20) and two patients were hypervolemic (CVP > 10 cmH2O) while seven patients were mild hyponatremic (126 - 132 mEq/L), four patients were moderate hyponatremic (121 - 125 mEq/L) and four patients were severe hyponatremic (≤ 120 mEq/ L). Ten patients were diagnosed as SIADH and five patients were diagnosed as CSW. Primary diagnosis in eight patients was subarachnoid haemorrhage. In conclusion, the fundamental difference between SIADH and CSW is their volume status. SIADH is a normovolemic or hypervolemic condition, while CSW is a hypovolemic condition and their treatments are also different. Anahtar Kelimeler : Cerebral salt wasting, central venous pressure, hyponatremia, inappropriate antidiuretic hormone secretion, syndrome