Neurologic and ophthalmologic complications of vascular access in a hemodialysis patient

Abstract

Patients on long-term hemodialysis undergo multiple interventions, including insertion of central catheters and arteriovenous anastomoses for creation of vascular access. The need for high-flow vessels to maintain hemodialysis efficiency leads to wear on the central veins and consequent stenosis and occlusion. In addition to local signs of impaired venous drainage, abnormal venous flow patterns involving the upper chest, face, and central nervous system might develop. We describe the first pediatric case of devastating intracranial hypertension presenting with visual loss in the eye contralateral to a high-flow vascular access in a patient on long-term hemodialysis. The literature on this rare complication of hemodialysis is reviewed.

Papilledema Due to a Permanent Catheter for Renal Dialysis and an Arteriovenous Fistula

“…There are 5 reported cases of patients with increased ICP linked to dialysis catheters or grafts, all with a combination of increased flow from the AVF and obstruction from venous stenosis or thrombosis (1)(2)(3)(4)(5). In 3 patients, papilledema resolved after ligation of the graft, 1 after balloon dilation to improve stenosis, and 1 patient's symptoms did not resolve before her illness progressed to brain infarction and death (Table 1).…”

Complications of central venous stenosis due to permanent central venous catheters in children on hemodialysis

“…However, although IOP correlates with CVP [3], glaucoma due solely to SVC stenosis has not been reported, and venous valves in the internal jugular veins prevent backward pressure transmission. To the contrary, glaucoma in patients with AVF has been reported, with at least one documented case of occluded SVC [4,5]. In case 1, when the AVF was occluded, despite the SVC still being blocked, the IOP normalized.…”

“…5. Increased intracranial pressure has previously been described in a few cases with SVC syndrome, some with devastating results including blindness, stroke or death [5,[11][12][13]. Elevated CVP may be transmitted to the intracranial veins and can also lead to decrease in CSF absorption [12].…”

Dynamics of a haemodynamic headache: A case report and literature review of headache secondary to flow inversion of the internal jugular vein

“…Only one of these case reports studied or reported both vertebral artery and jugular vein flows (4). Reports of headache in these patients were scarce and, when available, were not fully detailed (3–10) or described (6,11). Six case reports did not mention the presence of headache (2,8,12–15).…”