J Korean Soc Radiol.  2012 Mar;66(3):217-220. 10.3348/jksr.2012.66.3.217.

Dialysis Disequilibrium Syndrome-Induced Cerebral Edema in a Patient with Uremia Following Hemodialysis: A Case Report

Affiliations
  • 1Department of Radiology, Hallym University College of Medicine, Chuncheon Sacred Heart Hospital, Chuncheon, Korea. khc@hallym.or.kr

Abstract

Dialysis disequilibrium syndrome is a metabolic complication that can be caused by rapid removal of plasma urea during hemodialysis. Dialysis disequilibrium syndrome can lead to osmotic demyelinating syndrome. This case report describes one case of encephalopathy accompanied by dialysis disequilibrium syndrome with imaging findings acquired immediately after hemodialysis in a 55-year-old woman with chronic renal failure. The patient was observed to present repetitive seizures and sudden deterioration of consciousness immediately after hemodialysis. Shortly after the onset of symptoms, the patient underwent a CT scan. The imaging findings of the CT scan reveal symmetrical diffuse white matter edema of bilateral cerebral hemispheres that extends to the pons along the internal capsule. A follow-up MRI taken two years later shows that reversible changes without damage have occurred in the lesions. The patient can thus be seen to present symptoms characteristically associated with dialysis disequilibrium syndrome, while brain imaging reveals diffuse reversible brain edema.


MeSH Terms

Brain Edema
Cerebrum
Consciousness
Dialysis
Edema
European Continental Ancestry Group
Female
Follow-Up Studies
Humans
Internal Capsule
Kidney Failure, Chronic
Middle Aged
Neuroimaging
Plasma
Pons
Renal Dialysis
Seizures
Urea
Uremia
Urea

Reference

1. Ağildere AM, Kurt A, Yildirim T, Benli S, Altinörs N. MRI of neurologic complications in end-stage renal failure patients on hemodialysis: pictorial review. Eur Radiol. 2001. 11:1063–1069.
2. Tarhan NC, Agildere AM, Benli US, Ozdemir FN, Aytekin C, Can U. Osmotic demyelination syndrome in end-stage renal disease after recent hemodialysis: MRI of the brain. AJR Am J Roentgenol. 2004. 182:809–816.
3. Chua GC, Sitoh YY, Lim CC, Chua HC, Ng PY. MRI findings in osmotic myelinolysis. Clin Radiol. 2002. 57:800–806.
4. Patel N, Dalal P, Panesar M. Dialysis disequilibrium syndrome: a narrative review. Semin Dial. 2008. 21:493–498.
5. Bagshaw SM, Peets AD, Hameed M, Boiteau PJ, Laupland KB, Doig CJ. Dialysis Disequilibrium Syndrome: brain death following hemodialysis for metabolic acidosis and acute renal failure--a case report. BMC Nephrol. 2004. 5:9.
6. Chang CH, Hsu KT, Lee CH, Lee YC, Chiou TT, Chuang CH, et al. Leukoencephalopathy associated with dialysis disequilibrium syndrome. Ren Fail. 2007. 29:631–634.
7. Ağildere AM, Benli S, Erten Y, Coşkun M, Boyvat F, Ozdemir N. Osmotic demyelination syndrome with a dysequilibrium syndrome: reversible MRI findings. Neuroradiology. 1998. 40:228–232.
8. Chen CL, Lai PH, Chou KJ, Lee PT, Chung HM, Fang HC. A preliminary report of brain edema in patients with uremia at first hemodialysis: evaluation by diffusion-weighted MR imaging. AJNR Am J Neuroradiol. 2007. 28:68–71.
9. Chu K, Kang DW, Ko SB, Kim M. Diffusion-weighted MR findings of central pontine and extrapontine myelinolysis. Acta Neurol Scand. 2001. 104:385–388.
10. Kumar SR, Mone AP, Gray LC, Troost BT. Central pontine myelinolysis: delayed changes on neuroimaging. J Neuroimaging. 2000. 10:169–172.
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