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Thorsten Lenhard, MD; Stefan Schwab, MD

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We thank Dr Ronald Gurrera for his inspiring comments regarding our observation on cerebral salt-wasting syndrome (CSWS) in NMS.¹ But we also would like to emphasize that extrapolations from a single case to the pathophysiology of a complex disorder should be taken with necessary care. Many questions have to be addressed in the future to give us a more comprehensive understanding of the pathophysiology of CSWS as well as NMS. For example, the definitive origin of BNP in CSWS has to be resolved in detail, whether it arises from peripheral nervous tissue (most likely adrenal medulla) or central or both. Are there other natriuretic peptides or natriuretic active molecules involved? What are the mechanisms in other pathological states, such as subarachnoid hemorrhage (SAH)? Does CSWS in SAH^2-3 underlie also a dopamine deprivation and as a consequence a sympathoadrenal dysregulation as it suggests . . . [Full Text of this Article]

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Salt-Wasting and Hyponatremia in Neuroleptic Malignant Syndrome
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Cerebral Salt-Wasting Syndrome in a Patient With Neuroleptic Malignant Syndrome
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