Chronic portal-systemic shunt encephalopathy (CPSE) in a hemodialysis patient: A case report

Tanaka, Masahiro; Tsumatani, Kenichi; Mibu, Hisakazu; Ishii, Tadayoshi; Ozaki, Yomei; Nagayoshi, Junichi; Saka, Toshihisa

doi:10.4009/jsdt.36.223

Cited by 4 publications

(2 citation statements)

References 4 publications

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“…In the present two cases, we suspected the presence of congenital shunts, because CPSE developed prior to the initiation of hemodialysis in each patient. Initially, the preexisting shunts grew due to the progression of CKD and continuation of fluid overload (12,13). Subsequently, both the hyperammonemia and HE deteriorated as a result of an increased ammonia-rich blood flow into the systemic circulation, reflecting the existence of a pressure gradient between the IVC and PV (IVC-PV pressure gradient).…”

Section: Discussionmentioning

confidence: 99%

Two Cases of Hemodialysis-associated Chronic Portal-systemic Shunt Encephalopathy (CPSE) with Opposite Changes in the Blood Ammonia Concentrations during Hemodialysis: A Case Report and Literature Review

Okado

Togo

et al. 2015

Intern. Med.

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The onset of hyperammonemia due to the flow of ammonia-rich portal vein blood through a portalsystemic shunt causes a type of encephalopathy known as chronic portal-systemic shunt encephalopathy (CPSE). We herein report two cases of CPSE that presented with opposite changes in the blood ammonia concentrations during hemodialysis. It is curious that the encephalopathy was ameliorated by hemodialysis in case 1, but not case 2. Therefore, it is necessary to recognize CPSE and assess the blood ammonia concentrations in dialysis patients who develop a disturbance of consciousness, even if the serum transaminase level is normal.

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Section: Discussionmentioning

confidence: 99%

Two Cases of Hemodialysis-associated Chronic Portal-systemic Shunt Encephalopathy (CPSE) with Opposite Changes in the Blood Ammonia Concentrations during Hemodialysis: A Case Report and Literature Review

Okado

Togo

et al. 2015

Intern. Med.

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“…We reviewed 13 cases of HRPSE (Table) (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Of these patients, nine were women and the average patient age was 62.2 years (range, 32-80 years).…”

Section: Discussionmentioning

confidence: 99%

Hemodialysis-related Portal-Systemic Encephalopathy

et al. 2015

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Hemodialysis-related portal-systemic encephalopathy (HRPSE) is characterized by the presence of portosystemic encephalopathy without liver dysfunction, usually caused by changes in the systemic venous flow related to hemodialysis. We herein describe the case of a 75-year-old woman who developed hepatic encephalopathy five years after the initiation of hemodialysis. Abdominal contrast-enhanced computed tomography (CT) and three-dimensional CT angiography revealed a portosystemic venous shunt, and the patient was diagnosed with portosystemic encephalopathy. Occlusion therapy ameliorated her disturbance of consciousness. HRPSE should be recognized as a treatable neuropsychiatric disorder.

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Balloon-occluded retrograde transvenous obliteration was effective for hyperammonemia caused by chronic portal-systemic shunt encephalopathy in hemodialysis patient -A case report

史子¹,

美緒²,

まどか³

et al. 2012

Nihon Toseki Igakkai Zasshi

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Key words：chronic hemodialysis, short portal circulation, hyperammonemia, balloon-occluded retrograde transvenous obliteration 〈Abstract〉 We present the case of a 68-year-old male hemodialysis patient who developed portal-systemic shunt encephalopathy. Hemodialysis was started owing to diabetic nephropathy in April 2000. He previously underwent partial gastrectomy for gastric ulcer and blood transfusion. Since September 2004, fecal incontinence, some cognitive symptoms, and depression have sometimes occurred. Although he had been a heavy drinker and was a hepatitis C virus carrier, abdominal echography and computed tomography(CT)did not indicate any evidence of liver cirrhosis, and laboratory examination findings were normal except for the serum ammonia level, which was

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Chronic portal-systemic shunt encephalopathy (CPSE) in a hemodialysis patient: A case report

Cited by 4 publications

References 4 publications

Two Cases of Hemodialysis-associated Chronic Portal-systemic Shunt Encephalopathy (CPSE) with Opposite Changes in the Blood Ammonia Concentrations during Hemodialysis: A Case Report and Literature Review

Two Cases of Hemodialysis-associated Chronic Portal-systemic Shunt Encephalopathy (CPSE) with Opposite Changes in the Blood Ammonia Concentrations during Hemodialysis: A Case Report and Literature Review

Hemodialysis-related Portal-Systemic Encephalopathy

Balloon-occluded retrograde transvenous obliteration was effective for hyperammonemia caused by chronic portal-systemic shunt encephalopathy in hemodialysis patient -A case report

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