SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE SECRETION AND NEUROLOGICAL STROKE

OBJECTIVE; The purpose of this study was to find the frequency of Syndrome of inappropriate antidiuretic hormone
secretion (SIADH) in stroke patients
MATERIAL & METHODS; We conducted this prospective observational study in medical A unit Hayat Abad Medical
complex Peshawar from January 2011 to December 2011. After detailed history examination and investigations review
all diagnosed patients of neurological stroke were included in this study after informed consent. All patients were
screened for presence of hyponatremia (serum sodium <135 mmol per liter) by performing serum electrolyte. Those
having hyponatremia were further looked for presence of SIADH by performing serum osmolality, urinary sodium,arterial
blood gases and acid base balance. The diagnostic criteria for SIADH included Hyponatremia, Low serum osmolality,
High urinary sodium, High ratio of urine:serum osmolality, Normal renal, adrenal and thyroid function Normal serum
potassium and acid base balance and excluding Stroke patients with congestive cardiac failure, renal failure, cirrhosis,
Addison’s disease and patients with antipsychotic or diuretic medications.
Results; Total of 110 stroke patients were enrolled in this study. Male patients outnumbered female. Male patients were
59% and 41% were female. Mean age was 64 years (range 31 to 95 years).
All patients had focal neurological deficit. Left hemiplegia was observed in 38% patients while right hemiplegia was
present in 33.6% patients. Dysphasia alone was present in 11% patients and 17.2% patients were comatose. Right
cerebral infarct was present in 30% patients while 22.7% patients had left cerebral infarct. Right cerebral bleed was
documented in 14.5% patients and left cerebral bleed in 10% stroke patients and 9% patients had subarachenoid
hemorrhage while 13.6% patients had brain atrophy on brain imaging. Hyponatremia due to SIADH was documented
in 17% patients, comprising 6.3% patients of SAH, 5.45% patients of cerebral bleed, 3.6% patients of cerebral infarct
and 1.8% cerebral atrophy.
Conclusion; Syndrome of inappropriate antidiuretic hormone secretion is very common in stroke patients and subarachenoid
hemorrhage is leading stroke subtype causing SIADH.