Hemodialysis-Associated Acute Subdural Hematoma

Abstract

Subdural hematoma is an infrequent occurrence in association with hemodialysis. Because of its rarity, there is no widely accepted method of continuing dialysis in such patients. We describe a case of an interhemispheric subdural hematoma with apparent onset during hemodialysis, after which the patient was successfully managed with peritoneal dialysis for 7 weeks. Following this, hemodialysis was reinstated without recurrent intracranial hemorrhage. The strategy of prompt institution of peritoneal dialysis appears to be useful, and deserves serious consideration for long-term use in patients with subdural hematomas in light of the past record of high mortality with continued hemodialysis. However, it also appears that hemodialysis may be cautiously resumed after an appropriate interval of avoiding anticoagulation.

Peritoneal dialysis and acute kidney injury in acute brain injury patients

“…48 Nevertheless, case series on PD have shown that changes in intracranial pressure are lesser than in HD (with CPP even improving in some cases) and without the complications of anticoagulation. [49][50][51][52] 3.1 | Risk of an increase in intra-abdominal pressure and peritoneal dialysis…”

“…Despite more information regarding PD in AKI, there are few reports on this group of patients and its inappropriate use could increase cerebral edema, as occurs with other AKRT methods 48 . Nevertheless, case series on PD have shown that changes in intracranial pressure are lesser than in HD (with CPP even improving in some cases) and without the complications of anticoagulation 49–52 …”