Temporal Relationship between Hyponatremia and Development of Cerebral Vasospasm in Aneurysmal Subarachnoid Hemorrhage Patients: A Retrospective Observational Study

J Stroke Cerebrovasc Dis. 2020 Jun;29(6):104789. doi: 10.1016/j.jstrokecerebrovasdis.2020.104789. Epub 2020 Mar 20.


Background: Hyponatremia is a common complication after aneurysmal subarachnoid hemorrhage (aSAH). Previous studies have reported an association between hyponatremia and vasospasm, however whether hyponatremia directly contributes to the pathogenesis of cerebral vasospasm (CVS), or is a by-product is still unclear. The aim of this study was to explore an association between hyponatremia and CVS after aSAH, and evaluating the temporality of these 2 events.

Methods: A retrospective study of consecutive patients with aSAH admitted to the Baylor St. Luke's Medical center between January 2008 and December 2012 was conducted. Demographics, baseline characteristics, serum sodium levels, and evidence of vasospasm detected by transcranial Doppler, CT Angiogram, MR angiogram, and digital subtracted angiography were collected. Patients were dichotomized into a hyponatremic and a normonatremic group. CVS incidence and clinical outcome was compared between groups. Timing of CVS after initial hyponatremia episodes was recorded Results: One hundred and sixty 4 patients with aSAH were included. Hyponatremia was identified in 66 patients (40.2%) and CVS occurred in 71 subjects (43.2%). The incidence of CVS was higher in the hyponatremic group compared to the normonatremic group, 65.1 % versus 28.5%, respectively (P < .001). Hyponatremia preceded CVS by median 1.5 days suggesting a temporal trend.

Conclusions: Our study shows a significant association between hyponatremia and CVS, with hyponatremia preceding CVS events. This retrospective finding denotes the need for larger prospective studies, aiming to clarify the temporal relationship of serum sodium levels and CVS.

Keywords: Aneurysmal subarachnoid hemorrhage (aSAH); Glasgow outcome scale (GOS); cerebral vasospasm (CVS); hyponatremia; temporal relation; transcranial Doppler (TCD).

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Female
  • Humans
  • Hyponatremia / blood
  • Hyponatremia / diagnosis
  • Hyponatremia / epidemiology*
  • Incidence
  • Male
  • Middle Aged
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Sodium / blood*
  • Subarachnoid Hemorrhage / diagnosis
  • Subarachnoid Hemorrhage / epidemiology*
  • Texas / epidemiology
  • Time Factors
  • Vasoconstriction*
  • Vasospasm, Intracranial / diagnosis
  • Vasospasm, Intracranial / epidemiology*
  • Vasospasm, Intracranial / physiopathology


  • Biomarkers
  • Sodium