Cerebral Salt Wasting Syndrome Caused by Severe Traumatic Brain Injury in a Pediatric Patient and Review of the Literature.

BACKGROUND: Following acute traumatic brain injury, cerebral salt wasting (CSW) syndrome is considered as an important cause of hyponatremia apart from syndrome of inappropriate antidiuretic hormone. Differentiation between the two syndromes is crucial for the initiation of an adequate treatment. Case Presentation. We report a 15-year-old female adolescent, admitted to intensive care for acute severe traumatic brain injury. During his hospitalization, she developed a hyponatremia with an increase of urine output and hypovolemia. So, the most probable diagnosis was CSW. Initially, she was treated by hypertonic saline and volume expansion. However, his sodium level continued to fall despite infusion of hypertonic saline. That is why fludrocortisone was introduced initially at 50 µg/day then increased to 150 µg/day. Fludrocortisone was continued for the next months. Serum sodium level was 138 mmol/L after one month of treatment. CONCLUSION: Hyponatremia may occur after severe traumatic brain injury that is why an adequate treatment initiated on time is necessary in order to reduce morbidity and mortality.

Morel-Lavallée lesion as an unusual cause of hemorrhagic shock: Case report and review of literature.

INTRODUCTION: Morel-Lavallée syndrome (MLS) is considered as a rare entity and hemorrhagic shock as a complication is uncommon. PRESENTATION OF CASE: We report the case of a 56-year- old man who presented to the emergency department after a road traffic accident. Initially, the patient was hemodynamically unstable (heart rate 160 beats/min and blood pressure 65/30). Physical examination revealed multiple lacerations on his back and a gradually expanding large subcutaneous hematoma on the left flank extending to the hip and left leg. Fluid resuscitation was rapidly initiated. After stabilizing his hemodynamic status, a full-body computed tomography was performed revealing, apart from a small unilateral pneumothorax and a stable pelvis fracture, an extensive Morel-Lavallée lesion in the lumbar region extending to the hip and both legs. The patient was then transferred to a surgical intensive care unit for further resuscitation and surgical drainage of the collection followed by continuous suction was performed. Even though rare, Hemorrhagic shock is one of the threatening complications of Morel-Lavallée lesions and should be kept in mind by every traumatologist and emergency doctor. CONCLUSION: We report a case about a rare complication of MLS which is hemorrhagic shock in order to highlight the importance of making the diagnosis, which can be unrecognized, and initiate an adequate treatment on time.