- 期刊
Cerebral Salt Wasting Syndrome resulted from Chronic Subdural Effusion: A Case Report and Literature Review
慢性硬腦膜下積液引發大腦鹽分流失徵候群：病例報告與文獻回顧
摘要
Cerebral salt wasting (CSW) is not rare in the elder after traumatic brain injury(TBI). An emergency may develop once mental disturbance, seizure and respiratory distress happened. The mechanism of chronic subdural effusion (cSDE) induced CSW remains in a hypothetic status. We reported a 91-year-old man with a normal health for the past 40 years. He was first present at the emergent department owing to a TBI one month ago. This is his secondary visit due to progressively sleepy, weakness and stupor. The head computerized tomogram revealed bilateral frontal subdural effusions without significant mass effect. Laboratory data shew Na^+=119meg/dL; estimated glomerular filtration rate (eGFR)=57.9ml/min/1.73 and urine specific gravity (Uspgr)=1.003. He was then admitted to nephrotic ward. After intravenous administration of hyperosmotic saline for one week, his serum Na^+ was around 120 to 126meq/dL and consciousness levels befell inattention. A CSF shunt was performed. Thereafter, the serum Na^+= 134meq/dL; eGFR=69.2/ml/min/1.73 and urine Uspgr=1.010. The patient was discharged with alert status one week postoperatively. This study lends credence to support hyponatremia secondary to cSDE induced CSW, may lead to lethal morbidity, optimal surgical management and adjuvant fluid therapy leads a better result in this kind of cases.
並列摘要
老年人因頭部外傷引發的大腦鹽分流失徵候群並不少見，當引起患者意識改變及癲癇發作，呼吸窘迫時，就變成神經外科急症，外傷性硬腦膜下積液引發大腦鹽分流失徵候群病促成機轉依然存在假說階段。我們報導一位91歲男性，一個月曾因外傷而至急診，這次再造訪急診的原因為一星期以來，變得嗜睡，四肢無力。急診腦斷層檢查為雙側額葉慢性硬膜下積液，無壓迫腦實質的現象。血清檢查發現鈉離子濃度為119 meq/dL；腎絲球過濾率為57.9 ml/min/1.73；尿比重為1.010。基於上述發現，患者入住腎臟科病房接受為期一周高張輸液治療。期間鈉離子濃度介於120至126 meq/dL間。因此建議慢性硬膜下積液引流至腹腔手術治療。術後患者鈉離子濃度在一周左右逐漸升至134 meq/dL，意識清楚的狀況下出院。因此這個病人給我們的啟示，對於硬腦膜下積液引發大腦鹽分流失徵候群的疾患，正確診斷並積極手術治療及附加的輸液治療，可以減少患者的倂發症及死亡。