Authors:

Abstract

Introduction: Cerebral salt wasting syndrome (CSWS) and syndrome of inappropriate anti diuretic hormone (SIADH) secretion are the most common aetiological factors for developing hyponatremia following stroke. Though extracellular volume status is the key feature that helps to differentiate these two syndromes assessing the volume status is not an easy task. However, the differentiation of these two entities is crucial as the treatment options are completely different. Hence knowledge of the pathophysiological factors of CSWS is important to make an accurate diagnosis of CSWS. The objective of this review is to systematically evaluate the articles about the biochemical factors which involve in the pathophysiology of CSWS following subarachnoid haemorrhage (SAH).

Methods: A review of literature published in English was conducted in PubMed database without a date limitation. Three sets of search terms were used. The first set consisted of Medical Subject Heading (MeSH) terms“Cerebral salt wasting” and “Stroke”. The second set included the MeSH terms “Hyponatremia” and “Subarachnoid haemorrhage”. The last set included “Cerebral salt wasting” and “Subarachnoid haemorrhage”. Articles containing at least one word from each set were reviewed.

Results: At least one MeSH term from each set was incorporated in 296 articles. Of these, 163 were rejected as they were not related to cerebral salt wasting and subarachnoid haemorrhage.The association between the pathophysiology of natriuretic peptides and CSWS have been studied many times. There was only one study which evaluated the effect of cerebrospinal fluid adrenomedullin (CSF AM) on pathophysiology of CSWS.

Conclusion: Natriuretic peptides are involved in the pathophysiology of CSWS. However, the exact peptide which can cause CSWS is not well proven.

Keywords: Cerebral salt wasting syndrome, Cerebrospinal fluid adrenomedullin, Natriuretic peptides, Subarachnoid haemorrhage, Syndrome of inappropriate anti diuretic hormone secretion