The Significance of Hyponatremia Assessment before Surgical Intervention on the Confusion Table in the Borderline Subdural Hematoma

I. INTRODUCTION

For neurosurgeons, subdural hematoma is often considered a condition that requires immediate surgery. However, hyponatremia, syndrome of inappropriate antidiuretic hormone secretion (SIADH) and cerebral salt-wasting syndrome (CSWS) are very important in clinical practice of neurosurgery. If this fine detail is not overlooked, patients are protected from unnecessary operations. Our patient had characteristics that could cause this confusion. We did not rush to the surgical option and corrected hyponatremia. Thus, the patient's clinic improved without surgical intervention. We wanted to present this case in order to express this attention.

II. CASE DESCRIPTION

Our case is a 60-year-old male patient. When the patient was brought to the hospital emergency department as a result of head trauma, the patient was in a confused state and was blinking with an audible stimulus. So the eye score of glasgow coma scale was two (GCSE=2). Verbal communication was confused level. So the verbal score of glasgow coma scale was four (GCSV=4). He was localizing the painful stimulus. So the motor score of glasgow coma scale was five (GCSM=5). So the total GCS score was 11. (Table)

Laboratory measurements

The first cranial computed tomography scan of the patient had subdural hematomas of about 1 cm at its widest point and cranial fractures. (Figure 1 and 2) Significant hyponatremia was the notable finding in the hospital laboratory examination of the emergency department (124 mmol/lt).

Clinical course

The patient was followed up clinically, laboratory and radiologically. While there was no radiologic difference in cranial computed tomography taken on the same day and other days, clinically significant improvement occurred with early treatment of the hyponatremic table. (Figure 3) Following the treatment of hyponatremia, the blood sodium level rose to 127 mmol/l on the first day, 128 mmol/l on the next day and 139 mmol/l in a few days. Despite the absence of radiological regression in the hematoma or effusion of the patient, the patient's consciousness was fully opened with the recovery of hyponatremia and the patient began to establish normal verbal communication and began taking orders. So the GCS score was 15. The patient could be mobilized by opening the consciousness.

Comments

Funding: No funding was received for this research.

Conflict of Interest: Author declares that he has no conflict of interest.

Ethical approval: This article does not contain any studies with human participants or animals performed by the author.

Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.