Neurointervention.  2022 Mar;17(1):58-64. 10.5469/neuroint.2021.00444.

Central Venous Reflux, a Rare Cause of Neurological Manifestations in Hemodialysis Patients: A Case Report and Literature Review

• Caiza-Zambrano F
• Palacio CM
• Garbugino S
• Gonzalez FM
• Biolcati MB
• Saucedo MÁ
• Rugilo C
• Forrester M
• Lombi F
• Pardal MF
• Reisin R
• Bonardo P

• KMID: 2526628
• DOI: http://doi.org/10.5469/neuroint.2021.00444

Abstract

Central venous disease (CVD) is a serious complication in hemodialysis patients. Neurological manifestations are rare. We describe a female with end-stage renal disease with throbbing headache accompanied by paresthesia, weakness, and abnormal posture of her right hand during dialysis sessions. Motor symptoms completely resolved after each dialysis session, although the headaches persisted for several hours. No neurological deficit was evidenced on physical examination. Digital subtraction angiography identified an incomplete thrombosis of the left brachiocephalic vein with retrograde flow in the internal jugular vein, sigmoid sinus, and transverse sinus on the left side. This case illustrates that cerebral venous congestion due to CVD can produce neurological symptoms. Furthermore, we systematically review the literature to identify the characteristics of the cases described so far. This allows clinicians to know the entity and have a high index of suspicion in a hemodialysis patient who develops neurological symptoms.

Keyword

Neurologic manifestations; Renal dialysis; Venous thrombosis; Catheterization, central venous; Vascular access devices

Figure

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  Fig. 1. (A) Brain time-of-flight (TOF) magnetic resonance angiography (MRA) shows reflux venous flow in the sigmoid sinus, transverse sinus (white arrow), and inferior petrosal sinus (arrowhead) on the left side. (B) Brain TOF magnetic resonance venography shows reflux venous signals in the left transverse sinus (white arrow). (C, D) Neck TOF MRA demonstrates retrograde flow in the left internal jugular vein (IJV) (white arrow). (E) Digital subtraction angiography (DSA) after injection in the left brachial artery shows reflux venous flow in the left IJV (white arrow) and incomplete thrombosis of the left brachiocephalic vein (black arrow). (F) Delayed venous phase images of DSA show retrograde flow in the IJV, sigmoid sinus (white arrow), and transverse sinus (black arrow) on the left side.

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