RT Journal Article
SR Electronic
T1 Dialysis Disequilibrium Syndrome with Fatal Cerebral Edema (P05.210)
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP P05.210
OP P05.210
VO 80
IS 7 Supplement
A1 Stroup, Tiffani
A1 Nouh, Amre
A1 Wichter, Melvin
YR 2013
UL http://n.neurology.org/content/80/7_Supplement/P05.210.abstract
AB OBJECTIVE: To describe a case of delayed dialysis disequilibrium syndrome resulting in acute fatal cerebral edema.BACKGROUND: Dialysis disequilibrium is a rare phenomenon, which occurs more commonly in younger patients who are relatively new to dialysis. Manifestations range from headache, muscle cramps, and nausea, to seizures, altered sensorium and rarely coma or death. The pathogenesis is not fully understood, but proposed mechanisms include reverse urea effect, ideogenic osmoles, and paradoxical cerebral acidemia.DESIGN/METHODS: We report the case of a 21-year-old Hispanic male with end-stage renal disease on hemodialysis for the past month due to IgA nephropathy who presented with 2 reported seizures after a routine dialysis session. In the emergency department, the patient was unresponsive, intubated, with decerebrate posturing and intact brainstem reflexes. Stat imaging of the brain and intracranial vasculature including MRI was negative for ischemia, mass lesion or hydrocephalus. Cortical changes on flair were noted that were suggestive of early encephalitis. He was started on antiepileptics, broad-spectrum antibiotics, acyclovir and a lumbar puncture was performed. Cerebrospinal fluid was acellular with elevated protein at 257 mg/dL and normal opening pressure.RESULTS: Exam was stable overnight. The patient was dialyzed the following morning for severe hyperkalemia. Approximately 3 hours into dialysis, he developed absent brainstem reflexes. Stat imaging revealed massive diffuse cerebral edema. Despite all measures, he continued to deteriorate and died 4 days later.CONCLUSIONS: Although described in the literature, acute fatal cerebral edema following dialysis is not commonly seen. We hypothesize that the patient suffered acute cerebral edema due to dialysis disequilibrium syndrome. The rapid deterioration after the second dialysis session supports this hypothesis.Disclosure: Dr. Stroup has nothing to disclose. Dr. Nouh has nothing to disclose. Dr. Wichter has nothing to disclose.Wednesday, March 20 2013, 2:00 pm-7:00 pm