Leukoencephalopathy Associated with Dialysis Disequilibrium Syndrome

Abstract

Dialysis disequilibrium syndrome (DDS) is usually seen in severely uremic patients who are dialyzed aggressively. DDS mostly appeared within 24 hours after hemodialysis (HD) and may last for a few hours. This diagnosis is made by the exclusion of other causes including metabolic and intracranial events and has been recognized for more than 40 years. Few reports described the cerebral radiographic features associated with DDS. We present an 83-year-old uremic patient experiencing DDS at initial HD. DDS-related cerebral radiographic manifestations reported in the literature are reviewed, along with a discussion of the role of neuroimaging in the diagnosis of DDS.

Dialysis Disequilibrium Syndrome presenting as a focal neurological deficit

“…Follow‐up MRI revealed complete neurological recovery with normalization. This case illustrates the varied clinical and neuroradiological presentations of dialysis disequilibrium 5,8 …”

“…This case illustrates the varied clinical and neuroradiological presentations of dialysis disequilibrium. 5,8 Manuscript received October 2007; revised February 2008.…”

Diffuse Leukoencephalopathy Associated with Dialysis Disequilibrium Syndrome

“…Cases of diffuse leukoencephalopathy associated with DDS, similar to our case, have also been reported (5,14,15). Although Chang et al thought demyelination due to DDS was the cause in their case, they described that apparent diffusion images on MRI demonstrated increased signals in bilateral cerebral white matter (5).…”

“…Cases of diffuse leukoencephalopathy associated with DDS, similar to our case, have also been reported (5,14,15). Although Chang et al thought demyelination due to DDS was the cause in their case, they described that apparent diffusion images on MRI demonstrated increased signals in bilateral cerebral white matter (5). Based on studies of renal disease in rats (16) and in patients with end-stage renal disease (17), the cerebral edema of DDS is considered to be from diffuse interstitial edema and an ADC increase in white and gray matter.…”

“…As a cause of an unusual exacerbation of DDS, Chang et al suggested pre-existing CNS disease, i.e., an underlying age-related cerebral degenerative process and old ischemic infarcts (5). In reports of critical DDS cases, the complication of sepsis was thought to be the amplifier of cerebral edema through altered BBB permeability, which then led to brain herniation and death (3,4).…”