20Agrawal_LetterCerebral


 

 

 

 

 
Romanian Neurosurgery (2014) XXI 4        503 

 

 

 

 

 

 

 

Letter to the editor: 

Cerebral salt wasting syndrome following neurosurgical 

intervention in tuberculous meningitis 

Amit Agrawal 

Professor of Neurosurgery, Department of Neurosurgery, MM Institute of Medical Sciences & 

Research, Mullana (Ambala), India 

 
Dear Sir, 

Although rare but CSWS can develop in 

patients with hydrocephalus, cerebral 

infarction, tuberculous meningitis and can 

also complicate the postoperative course of 

surgery for brain tumors or for severe head 

injury. (1, 2, 3) The pathogenesis of CSWS is 

still not completely understood and it has been 

proposed that following acute insult 

sympathetic responses as well as some 

natriuretic factors play a role in the genesis of 

this syndrome. (4, 5) Many time it is difficult 

to identify whether the CSWS occurred due to 

tuberculous meningitis per se or due to the 

neurosurgical intervention which was done on 

the day of admission. (1) We need to be aware 

of this potentially treatable complication, 

however the occurrence of the CSWS in the 

present cases probably can be the 

manifestation of complication of tubercular 

meningitis (basal arteritis leading to ischemic 

injury to the brain) rather than the 

complication of neurosurgical intervention. 

 

Correspondence 

Dr. Amit Agrawal 

Professor of Neurosurgery 

MM Institute of Medical Sciences & Research  

Mullana (Ambala) 

PIN- 133203 

Haryana, India. 

Phone: +91- 01731-274475 

Fax: +91- 01731-274375  

Email: dramitagrawal@gmail.com  

dramit_in@yahoo.com 

References 

1. Nagotkar L, Shanbag P, Dasarwar N. Cerebral Salt 
Wasting Syndrome Following Neurosurgical 

Intervention in Tuberculous Meningitis. Indian 

Pediatrics 2008;45:598-601.   

2. Jiménez R, Casado-Flores J, Nieto M, García-Teresa 
MA. Cerebral salt wasting syndrome in children with 

acute central nervous system injury. Pediatr Neurol. 

2006;35(4):261-3.  

3. Ravishankar B, Mangala , Prakash GK, Shetty KJ, Ballal 
HS. Cerebral salt wasting syndrome in a patient with 

tuberculous meningitis. J Assoc Physicians India. 

2006;54:403-4. 

4. Cerdà-Esteve M, Cuadrado-Godia E, Chillaron JJ, 
Pont-Sunyer C, Cucurella G, Fernández M, Goday A, 

Cano-Pérez JF, Rodríguez-Campello A, Roquer J. 

Cerebral salt wasting syndrome: review. Eur J Intern Med. 

2008 Jun;19(4):249-54.  

5. Isotani E, Suzuki R, Tomita K, et al. Alterations in 
plasma concentrations of natriuretic peptides and 

antidiuretic hormone after sub-arachnoid haemorrhage. 

Stroke 1994;25:2198-203. 

6. Dass R, Nagaraj R, Murlidharan J, Singhi S. 
Hyponatraemia and hypovolemic shock with tuberculous 

meningitis. Indian J Pediatr. 2003;70(12):995-7.