Severe venous congestive encephalopathy secondary to a dialysis arteriovenous graft

Abstract

The clinical presentation and imaging of venous congestive encephalopathy (VCE) can mimic several neurological conditions, making the diagnosis challenging. We report a patient with end stage renal disease on dialysis who presented with a right occipital infarction. The patient developed progressive encephalopathy and increased intracranial pressure. Extensive imaging, electroencephalography and serum analysis did not explain the cause of his infarction and progressive neurological deterioration. Finally, cerebral angiography and venography demonstrated severe generalized VCE due to arterial shunting from a right upper extremity arteriovenous graft (AVG) and an occluded right innominate venous trunk. The right arm shunt resulted in severe cerebral venous hypertension due to ipsilateral occlusion of the innominate venous trunk. After the AVG was repaired, the cerebral venous hypertension resolved and the patient returned to baseline.

Neurological Symptoms Due to Intracranial Venous Congestion in a Hemodialysis Patient With Arteriovenous Shunted Flow

“…[5][6][7] In addition, albeit rare, the occurrence of venous congestive encephalopathy and subarachnoid hemorrhage has also been reported. 7,8 Here, we report a case of cerebral hemorrhage due to intracranial venous congestion in a hemodialysis patient with an AVG in her left forearm. The intracranial venous congestion had developed via blood flow from the AVG, severe stenosis of the left brachiocephalic vein, and backward flow of the left internal jugular vein.…”

Cerebral Infarction due to Central Vein Occlusion in a Hemodialysis Patient

“…Venous congestive encephalopathy (VCE) is a rare complication of central venous occlusion in hemodialysis patients with upper extremity dialysis created shunts . It can present with a variety of nonspecific neurological signs and symptoms, mimicking a range of differing neurological diagnoses . As a result, diagnosis is often delayed and can lead to irreversible neurological deficits from cerebral infarction.…”

“…1 It can present with a variety of nonspecific neurological signs and symptoms, mimicking a range of differing neurological diagnoses. 2 As a result, diagnosis is often delayed and can lead to irreversible neurological deficits from cerebral infarction. We report an institutional review board-approved case of an end-stage renal disease (ESRD) patient with a left upper extremity arteriovenous (AV) graft who developed a left brachiocephalic vein occlusion, resulting in flow reversal within the left internal jugular vein (IJV).…”

B-type (brain) natriuretic peptide and pruritus in hemodialysis patients

“…Severe venous congestive encephalopathy resulting from arteriovenous graft and cerebral hemorrhage due to internal jugular vein stenosis has been reported as cerebral venous hypertension. 23,24 Thus, hemodialysis patients are at high risk for venous hypertension resulting in intracranial hypertension. These conditions induce a high level BNP in both serum and CSF.…”