Risk factors and treatment strategies for hyponatremia following aneurysm clipping in patients with aneurysmal subarachnoid hemorrhage: A Single Center experience

Background: Hyponatremia is one of the most common complications following aneurysmal subarachnoid hemorrhage (aSAH). This condition can exacerbate secondary injuries, such as cerebral edema, thereby leading to increased intracranial pressure and adversely affecting patient outcomes. Methods: This study aims to investigate the factors associated with hyponatremia in patients following aSAH and to evaluate effective treatment strategies. We conducted a retrospective analysis of clinical data from 102 patients with aSAH. Based on the presence or absence of hyponatremia post-hemorrhage, patients were categorized into a hyponatremia group and a normonatremic group. Statistical analyses were performed on variables including gender, age, aneurysm location, Hunt-Hess grade, presence of hydrocephalus, duration of surgery, intraoperative blood loss, and postoperative lumbar cistern drainage. Treatment strategies were tailored according to the type of hyponatremia, distinguishing between Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) and Cerebral Salt-Wasting Syndrome (CSWS). Results: Among 102 patients with aSAH, 40 cases developed hyponatremia. Through the implementation of appropriate treatment regimens, hyponatremia was successfully resolved in all affected patients. Univariate analysis revealed that the location of the aneurysm, Hunt-Hess grade, the presence of hydrocephalus, and lumbar cistern drainage were significant factors influencing postoperative hyponatremia. In contrast, variables such as sex, age, duration of surgery, and intraoperative blood loss were not statistically significant. Further analysis identified that aneurysms located in the anterior cerebral artery and anterior communicating artery, Hunt-Hess grade Ⅲ-IV, and the presence of hydrocephalus were independent risk factors for the development of hyponatremia in patients with aneurysmal SAH. Conclusion: Patients with aSAH are particularly susceptible to developing hyponatremia. This risk is notably higher among individuals with aneurysms located in the anterior communicating artery or anterior cerebral artery, those presenting with high Hunt-Hess grade, or those with concurrent hydrocephalus. For such patients, vigilant monitoring and timely intervention are essential to mitigate the incidence of hyponatremia. Tailoring treatment strategies based on the specific subtype of hyponatremia can significantly improve clinical outcomes.