Cerebral Computed Tomography in Uremic and Hemodialyzed Patients

Cusmano, F; Savazzi, G

doi:10.1097/00004728-198607000-00003

Cited by 22 publications

(18 citation statements)

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“…In a study of 50 patients receiving regular hemodialysis, CT showed cerebral atrophy in about half of the cases, and a correlation was found between cortical atrophy and duration of disease (Cusmano and Savazzi, 1986).…”

Section: Resultsmentioning

confidence: 95%

Increased Cerebral Blood Flow in Anemic Patients on Long-Term Hemodialytic Treatment

Vorstrup

Lass

Waldemar

et al. 1992

J Cereb Blood Flow Metab

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Summary: CBP was measured in 15 patients on chronic hemodialytic treatment. CBP was measured with xenon-133 inhalation using single photon emission tomography. In addition, computerized tomography (CT) and a neuro logical examination were done prior to hemodialysis. Mean CBP was 66.2 ± 17.3 (SD) ml 100 g-I min-I, which was significantly higher (t-test, p < 0.05) than for an age-matched control group (54.7 ± 10.2 ml 100 g-I min -I). However, the hematocrit for the patients was considerably lower, 0.30 ± 0.07, as compared to 0.43 ± 0.03 in the controls. A significant negative correlation was observed between CBP and the hematocrit (y = -1.79x + 120.7, r = -0.71, p < 0.01). Calculating CBP from this equation in the dialyzed patients using a hematAs focal or diffuse brain tissue damage is invari ably followed by a reduction in CBF, there are rea sons to expect a CBF decrease in patients on long term hemodialytic treatment. First, the renal dis ease itself may cause uremic encephalopathy (Olsen, 1961;Tyler, 1968), although today most pa tients will receive hemodialysis early in the course of their disease to prevent long-standing severe ure mia. Second, a severe progressive neurological syn drome called dialysis dementia evolves in a number of patients regularly treated with hemodialysis. The etiology of this syndrome was originally found to relate to a high aluminum content in the dialysate (Alfrey et aI., 1976;Alfrey, 1987). Lately, it has Received November 22, 1991; final revision received March 18, 1992; accepted March 18, 1992. Address correspondence and reprint requests to Dr. Sissel Vorstrup, Department of Neurology, Rigshospitalet, 9, Blegdamsvej, 2100 Copenhagen, Denmark.Abbreviations used: CT, computed tomography; CM, can thomeatal (plane); Hct, hematocrit; PET, positron emission to mography. 745ocrit of 0.43 yielded a mean CBP value of 43.7 mlloo g-I min -I, i.e., 20% below the expected. Two patients showed a focal CBP decrease. CT showed central or cor tical atrophy in five patients, and two had small hypo dense lesions. The neurological examination revealed slight to moderate dementia in seven cases. Although mean CBP was found to be increased by 21% as com pared to the control group, an even higher CBP level would have been expected to outweigh the decreased ox ygen carrying capacity of the blood. The findings suggest a lowered metabolic demand of the brain tissue, probably due to subtle brain damage. Key Words: Anemia-CBP Hemodialysis.been suggested that even the moderately increased aluminum levels in the blood, often seen in these patients because of a high daily intake of aluminum containing phosphate-binding gels, may cause de mentia (Altmann et aI., 1989). Third, hypotensive episodes, arterial hypoxemia, and fluctuations in electrolytes and cerebral water content may occur during hemodialysis and cause subtle subclinical brain tissue damage (Savazzi et aI., 1985). Finally, the underlying process for the renal disease could cause brain damage and thereby decrease CBF. We therefore studied the in...

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Section: Resultsmentioning

confidence: 95%

Increased Cerebral Blood Flow in Anemic Patients on Long-Term Hemodialytic Treatment

Vorstrup

Lass

Waldemar

et al. 1992

J Cereb Blood Flow Metab

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“…Cusmano and Savazzi showed that 10% of CKD patients, most of whom were undergoing hemodialysis, had SBIs. 35 More recently, we found a strong association between eGFR and intracranial artery calcification in patients hospitalized for stroke or nonvascular neurologic disorders. 36 This is not surprising, given that CKD is associated with an accelerated, active vascular calcification process.…”

Section: Brain Lesions In Ckd Patientsmentioning

confidence: 83%

Cognitive Disorders and Dementia in CKD

Bugnicourt

Godefroy

Chillon

et al. 2013

Journal of the American Society of Nephrology

477

431

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Epidemiologic data suggest that individuals at all stages of CKD have a higher risk of developing cognitive disorders and dementia. This risk is generally explained by the high prevalence of both symptomatic and subclinical ischemic cerebrovascular lesions. However, other potential mechanisms, including direct neuronal injury by uremic toxins, could also be involved, especially in the absence of obvious cerebrovascular disease. We discuss the prevalence and characteristics of cognitive disorders and dementia in patients with CKD, brain imaging findings, and traditional and nontraditional risk factors. Understanding the pathophysiologic interactions between renal impairment and brain function is important in order to minimize the risk for future cognitive impairment.

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“…Cerebral atrophy in uremic patients has been described previously [1][2][3][4][5][6]. Passer [1] first demonstrated in 1977 marked enlargement of the ventricles using CT in uremic patients as compared to age-matched controls.…”

Section: Discussionmentioning

confidence: 99%

“…Cerebral atrophy in chronic hemodialysis patients has been demonstrated since the second half of the 1970s when computed tomography (CT) began to be used widely [1][2][3][4][5][6]. Various factors related to uremia or hemodialysis might cause cerebral atrophy.…”

Section: Introductionmentioning

confidence: 99%

“…Though the aging process is also known to contribute to cerebral atrophy, few studies have been done in young hemodialysis patients who are free from senile changes. In addition, previous studies evaluated the morphologic change of brain qualitatively [3,[5][6][7], but not quantitatively. Therefore, it is not clear whether any factor other than cerebrovascular disease and aging process contrib- uted to the reported cerebral atrophy in hemodialyzed patients.…”

Section: Introductionmentioning

confidence: 99%

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Morphologic Abnormalities in the Brain of Chronically Hemodialyzed Patients without Cerebrovascular Disease

et al. 2000

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In this study, the authors evaluated the cerebral atrophy in 56 chronic hemodialyzed patients, who did not have clinical episodes or radiologic findings of cerebrovascular diseases, and 42 controls. Using computed tomography (CT) images, brain atrophy index (BAI), the proportion of subarachnoidal plus ventricular space in the cranial cavity, and ventricular area index (VAI), percent area of ventricle in the brain, were calculated. CT of the brain demonstrated an age-dependent increase in BAI in both hemodialyzed patients and controls. BAI and VAI were greater in hemodialyzed patients than healthy controls and the difference was significant at ages under 60 years in BAI and at ages less than 50 years in VAI. The atrophy of the frontal parts of the brain in patients on hemodialysis for 10 years or more was significantly greater than in patients dialyzed for less than 10 years. There was a significant negative correlation between BAI or VAI and hematocrit. These findings indicate that renal failure or hemodialysis itself might cause cerebral atrophy, and that the cerebral atrophy is more prominent in patients on hemodialysis for a long duration and with low hematocrit.

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Cerebral Computed Tomography in Uremic and Hemodialyzed Patients

Cited by 22 publications

References 0 publications

Increased Cerebral Blood Flow in Anemic Patients on Long-Term Hemodialytic Treatment

Increased Cerebral Blood Flow in Anemic Patients on Long-Term Hemodialytic Treatment

Cognitive Disorders and Dementia in CKD

Morphologic Abnormalities in the Brain of Chronically Hemodialyzed Patients without Cerebrovascular Disease

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