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Cerebral Salt-Wasting Syndrome Caused by Minor Head Injury. Case Rep Emerg Med 2017; 2017:8692017. [PMID: 28194285 PMCID: PMC5282430 DOI: 10.1155/2017/8692017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 12/04/2016] [Indexed: 11/30/2022] Open
Abstract
A 34-year-old woman was admitted to hospital after sustaining a head injury in a motor vehicle accident (day 1). No signs of neurological deficit, skull fracture, brain contusion, or intracranial bleeding were evident. She was discharged without symptoms on day 4. However, headache and nausea worsened on day 8, at which time serum sodium level was noted to be 121 mEq/L. Treatment with sodium chloride was initiated, but serum sodium decreased to 116 mEq/L on day 9. Body weight decreased in proportion to the decrease in serum sodium. Cerebral salt-wasting syndrome was diagnosed. This case represents the first illustration of severe hyponatremia related to cerebral salt-wasting syndrome caused by a minor head injury.
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Bellante F, Legros B, Depondt C, Créteur J, Taccone FS, Gaspard N. Midazolam and thiopental for the treatment of refractory status epilepticus: a retrospective comparison of efficacy and safety. J Neurol 2016; 263:799-806. [PMID: 26914931 DOI: 10.1007/s00415-016-8074-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/12/2016] [Accepted: 02/15/2016] [Indexed: 11/25/2022]
Abstract
Current management guidelines for refractory status epilepticus (RSE) recommend the use of intravenous continuous anesthetic therapy, but there is little evidence to guide the selection of the most efficacious and safest drug. We conducted a retrospective study to evaluate the efficacy and safety of midazolam versus thiopental for treatment of RSE. Retrospective case-control series of prospectively identified patients treated with midazolam or thiopental for RSE between January 2007 and December 2014. The primary outcome was control of RSE. Secondary outcomes included the rate of adverse events, intensive care unit (ICU) and hospital length of stay, hospital mortality and long-term neurological outcome, assessed with the extended Glasgow outcome scale (GOS-E) at discharge and at six 6 months. A total of 33 patients were included, 19 treated with midazolam and 14 with thiopental. Groups were similar for demographic data, clinical variables, comorbidity and the underlying cause of RSE. The rate of control of SE did not differ between groups (63 vs. 64 %). Adverse events including hypotension (mean arterial pressure <70 mmHg) requiring vasopressors, infections, anemia requiring red blood cells transfusion, leucopenia (<4000/mm(3)), and hyponatremia (<130 mEq/l) were more frequent during thiopental infusion. Furthermore, patients treated with midazolam had a shorter median ICU length of stay (6 vs. 15 days; p = 0.02) and better GOS-E at 6 months (8 [8] vs. 4 [4, 5]; p = 0.01). These findings suggest that continuous midazolam administration is as efficacious as thiopental infusion for the treatment of RSE; however, midazolam was associated with a significantly lower number of adverse events. These findings should be confirmed in larger multicenter trials.
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Affiliation(s)
- Flavio Bellante
- Department of Neurology, Université Libre de Bruxelles-Hôpital Erasme, Route de Lennik, 808, 1070, Brussels, Belgium
- Department of Neurology, Centre Hospitalier Universitaire Tivoli, La Louvière, Belgium
| | - Benjamin Legros
- Department of Neurology, Université Libre de Bruxelles-Hôpital Erasme, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Chantal Depondt
- Department of Neurology, Université Libre de Bruxelles-Hôpital Erasme, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Jacques Créteur
- Department of Intensive Care, Université Libre de Bruxelles-Hôpital Erasme, Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Université Libre de Bruxelles-Hôpital Erasme, Brussels, Belgium
| | - Nicolas Gaspard
- Department of Neurology, Université Libre de Bruxelles-Hôpital Erasme, Route de Lennik, 808, 1070, Brussels, Belgium.
- Division of Clinical Neurophysiology, Department of Neurology, Comprehensive Epilepsy Center, Yale University School of Medicine, New Haven, CT, USA.
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Leonard J, Garrett RE, Salottolo K, Slone DS, Mains CW, Carrick MM, Bar-Or D. Cerebral salt wasting after traumatic brain injury: a review of the literature. Scand J Trauma Resusc Emerg Med 2015; 23:98. [PMID: 26561391 PMCID: PMC4642664 DOI: 10.1186/s13049-015-0180-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/06/2015] [Indexed: 11/10/2022] Open
Abstract
Electrolyte imbalances are common among patients with traumatic brain injury (TBI). Cerebral salt wasting (CSW) is an electrolyte imbalance characterized by hyponatremia and hypovolemia. Differentiating the syndrome of inappropriate antidiuretic hormone and CSW remains difficult and the pathophysiological mechanisms underlying CSW are unclear. Our intent was to review the literature on CSW within the TBI population, in order to report the incidence and timing of CSW after TBI, examine outcomes, and summarize the biochemical changes in patients who developed CSW. We searched MEDLINE through 2014, hand-reviewed citations, and searched abstracts from the American Association for the Surgery of Trauma (2003-2014). Publications were included if they were conducted within a TBI population, presented original data, and diagnosed CSW. Publications were excluded if they were review articles, discussed hyponatremia but did not differentiate the etiology causing hyponatremia, or presented cases with chronic disease. Fifteen of the 47 publications reviewed met the selection criteria; nine (60%) were case reports, five (33%) were prospective and 1 (7%) was a retrospective study. Incidence of CSW varied between 0.8 - 34.6%. The populations studied were heterogeneous and the criteria used to define hyponatremia and CSW varied. Though believed to play a role in the development of CSW, increased levels of natriuretic peptides in patients diagnosed with CSW were not consistently reported. These findings reinforce the elusiveness of the CSW diagnosis and the need for strict and consistent diagnostic criteria.
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Affiliation(s)
- Jan Leonard
- Department of Trauma Research, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO, 80113, USA. .,Department of Trauma Research, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO, 80228, USA. .,Department of Trauma Research, The Medical Center of Plano, 3901 West 15th St, Plano, TX, 75075, USA.
| | - Raymond E Garrett
- Department of Trauma Research, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO, 80113, USA. .,Craig Hospital, 3425 S. Clarkson St, Englewood, CO, 80113, USA.
| | - Kristin Salottolo
- Department of Trauma Research, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO, 80113, USA. .,Department of Trauma Research, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO, 80228, USA. .,Department of Trauma Research, The Medical Center of Plano, 3901 West 15th St, Plano, TX, 75075, USA.
| | - Denetta S Slone
- Trauma Services Department, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO, 80113, USA.
| | - Charles W Mains
- Trauma Services Department, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO, 80228, USA.
| | - Matthew M Carrick
- Trauma Services Department, The Medical Center of Plano, 3901 West 15th St, Plano, TX, 75075, USA.
| | - David Bar-Or
- Department of Trauma Research, Swedish Medical Center, 501 E. Hampden Ave, Englewood, CO, 80113, USA. .,Department of Trauma Research, St. Anthony Hospital, 11600 W. 2nd Place, Lakewood, CO, 80228, USA. .,Department of Trauma Research, The Medical Center of Plano, 3901 West 15th St, Plano, TX, 75075, USA.
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