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2015 ; 15
(ä): 201
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Polyuria and cerebral vasospasm after aneurysmal subarachnoid hemorrhage
#MMPMID26462796
Brown RJ
; Epling BP
; Staff I
; Fortunato G
; Grady JJ
; McCullough LD
BMC Neurol
2015[Oct]; 15
(ä): 201
PMID26462796
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BACKGROUND: Natriuresis with polyuria is common after aneurysmal subarachnoid
hemorrhage (aSAH). Previous studies have shown an increased risk of symptomatic
cerebral vasospasm or delayed cerebral ischemia (DCI) in patients with
hyponatremia and/or the cerebral salt wasting syndrome (CSW). However,
natriuresis may occur in the absence of hyponatremia or hypovolemia and it is not
known whether the increase in DCI in patients with CSW is secondary to a
concomitant hypovolemia or because the physiology that predisposes to natriuretic
peptide release also predisposes to cerebral vasospasm. Therefore, we
investigated whether polyuria per se was associated with vasospasm and whether a
temporal relationship existed. METHODS: A retrospective review of patients with
aSAH was performed. Exclusion criteria were admission more than 48 h after
aneurysmal rupture, death within 5 days, and the development of diabetes
insipidus or acute renal failure. Polyuria was defined as > 6 liters of urine in
a 24 h period. Vasospasm was defined as a mean velocity > 120 m/s on Transcranial
Doppler Ultrasonography (TCDs) or by evidence of vasospasm on computerized
tomography (CT) or catheter angiography. Multivariable logistic regression was
performed to assess the relationship between polyuria and vasospasm. RESULTS: 95
patients were included in the study. 51 had cerebral vasospasm and 63 met the
definition of polyuria. Patients with polyuria were significantly more likely to
have vasospasm (OR 4.301, 95% CI 1.378-13.419) in multivariate analysis. Polyuria
was more common in younger patients (52 vs 68, p <.001) but did not impact
mortality after controlling for age and disease severity. The timing of the
development of polyuria was clustered around the diagnosis of vasospasm and
patients with polyuria developed vasospasm faster than those without polyuria.
CONCLUSIONS: Polyuria is common after aSAH and is significantly associated with
cerebral vasospasm. The development of polyuria may be temporally related to the
development of vasospasm. An increase in urine volume may be a useful clinical
predictor of patients at risk for vasospasm.
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