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March 1970

Subdural HematomaWith Inappropriate Antidiuretic Hormone Secretion

Author Affiliations

From the Department of Neurological Surgery, Indiana University Medical Center, Indianapolis.

Arch Neurol. 1970;22(3):234-239. doi:10.1001/archneur.1970.00480210044005

"CEREBRAL salt-wasting" describes the findings of hyponatremia and excessive renal sodium excretion in patients with various affections of the central nervous system (CNS). Formerly, these electrolyte alterations in patients with cerebral disease were ascribed to a decrease in corticotropin (ACTH) secretion or to direct interference with the neural control of renal tubular sodium reabsorption.1,2 In 1957, Schwartz and co-workers3 reported similar electrolyte findings in two patients with bronchogenic carcinoma and suggested that abnormal or inappropriate release of antidiuretic hormone (ADH) was the pathogenic abnormality. Since then, the syndrome of inappropriate ADH secretion (SIADH) has been documented in patients with inflammatory, vascular, degenerative, and traumatic disorders of the CNS. Moreover, recent reports indicate that this is by no means a rare syndrome.4,5

Regardless of the underlying cerebral disease, the clinical picture may be dominated by the neurologic manifestations associated with hyponatremia. Apathy, weakness, dizziness, and headaches

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