Acute Blindness During Hemodialysis: Neuroimaging in Diagnosis

Abstract

A cute blindness during hemodialysis is very rare. It is important to fi nd out the real etiology before beginning treatment. The etiology might include anterior or posterior ischemic optic neuropathy, acute cerebral infarction, or reversible posterior encephalopathy syndrome (RPES). We sought to emphasize the importance of diffusionweighted imaging (DWI), apparent diffusion coeffi cient (ADC) mapping, and magnetic resonance spectroscopy (MRS) for diagnosis. Close collaboration among nephrologists, neuro-ophthalmologists, and radiologists is important in this interdisciplinary emergency. Case ReportA 48-year-old woman with chronic renal failure developed acute blindness during hemodialysis. Cranial computerized tomography (CT) was reported as normal. For this reason, an emergent cranial magnetic resonance imaging (MRI), as well as a DWI, ADC mapping, and MRS were performed in less than 6 hours after the incident on a 1.5 T whole body MRI system (Excite, General Electric, Milwaukee, Wisc.) with a 33 mT/m maximum ABSTRACT: Acute blindness related to hemodialysis is very rare. It is important to fi nd out the real etiology before beginning treatment. In this case, we sought to emphasize the importance of diffusion-weighted imaging, apparent diffusion coeffi cient mapping, and magnetic resonance spectroscopy for diagnosis. Close collaboration among nephrologists, neuro-ophthalmologists, and radiologists is important in this interdisciplinary emergency.

Central vein stenosis: a rare cause of orbital congestion in a haemodialysis patient

“…Haemodialysis plays an important role as a renal replacement therapy in patients with end-stage renal disease (ESRD), but acute blinding ocular complications may occur, which are mostly related to accelerated hypotension during haemodialysis 1. Posterior reversible encephalopathy syndrome and cortical infarct causing visual loss have also been reported in haemodialysis patients, and optic atrophies are common,2 especially in chronic anaemia and ischaemia resulting from underlying multiple comorbidities; otherwise, ocular complications related to haemodialysis catheters are uncommon. We describe such an uncommon case of unilateral orbital congestion with dilated neck and facial veins caused by central venous stenosis in a patient with ESRD undergoing haemodialysis.…”