Uremic Encephalopathy: MR Imaging Findings and Clinical Correlation

Kim, D.M.; Lee, Inho; Song, Chang June

doi:10.3174/ajnr.a4776

Cited by 79 publications

(86 citation statements)

References 31 publications

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“…Regardless the reason, the breakdown of the blood-brain barrier is the key factor of the imaging manifestations [9]. MRI predominantly reveals vasogenic edema but cytotoxic edema has been reported in UE and PRES [1, 3, 4]. The imaging manifestations of our patient showed hyperintensity on T2WI and FLAIR but normal intensity on DWI, which represented vasogenic edema.…”

Section: Discussionmentioning

confidence: 72%

“…The pathophysiology of PRES is thought to be the dysfunction of vascular autoregulation whereas UE is likely caused by the effects of neurotoxic compounds [1]. Regardless the reason, the breakdown of the blood-brain barrier is the key factor of the imaging manifestations [9].…”

Section: Discussionmentioning

confidence: 99%

“…There are 3 patterns of imaging findings in patients with UE: involving the basal ganglia, cortical or subcortical regions, and white matter [1]. Cortical involvement of UE is a category of posterior reversible encephalopathy syndrome (PRES) and basal ganglia involvement is rare [1, 2], the white matter involvement is limited to case reports [3, 4]. We came across a reported case of UE caused by neurogenic bladder that presented isolate involvement of the brainstem on magnetic resonance imaging (MRI).…”

Section: Introductionmentioning

confidence: 99%

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Uremic encephalopathy with isolated brainstem involvement revealed by magnetic resonance image: a case report

Jia

Zhang

et al. 2017

BMC Neurol

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BackgroundUremic Encephalopathy (UE) is a neurological complication associated with acute or chronic renal failure. Imaging findings of UE may present involvement of the basal ganglia, cortical or subcortical regions, and white matter. We report a rare case of UE caused by neurogenic bladder with isolated brainstem involvement revealed by magnetic resonance imaging (MRI). Immediate therapy resulted in full recovery of neurological signs and changes on MRI.Case presentationA 14-year-old Han Chinese woman with a history of chronic renal failure caused by neurogenic bladder. On admission, she was unconscious and her pupils presented different sizes, while her vital signs were normal. MRI showed high signal in the dorsal pontine base and in the mid brain on fluid-attenuated inversion-recovery (FLAIR) imaging and on T2-weighted imaging while the signal was normal on diffusion-weighted images (DWI). Blood analysis revealed renal failure and acidosis. After urinary retention treatment and acidosis correction, the patient soon recovered. Follow-up MRI 2 months after the discharge revealed complete resolution of UE in the brainstem.ConclusionWe reported a rare case of a patient with UE that had unusual imaging manifestations for whom timely diagnosis and treatment assured recovery.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Uremic encephalopathy with isolated brainstem involvement revealed by magnetic resonance image: a case report

Jia

Zhang

et al. 2017

BMC Neurol

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“…1 This case report highlights a rare clinical feature of UE, that is, choreoathetosis with its characteristic radiological correlation, a "lentiform fork sign." Uremic encephalopathy (UE), believed due to brain dysfunction from accumulation of uremic toxins, can be ameliorated completely or partially by dialysis.…”

Section: Introductionmentioning

confidence: 84%

Lentiform fork sign: Uremia alone or multifactorial causation?

Jaryal

Thakur

Pathania

et al. 2019

Hemodialysis International

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Neurological complications are common in patients with acute or chronic renal failure, especially when there is marked reduction in the glomerular filtration rate (GFR). One such clinical syndrome, uremic encephalopathy (UE), occurs due to widespread dysfunction of central nervous system (CNS). It manifests with myriad clinical features and usually is suggested by bedside elicitation of asterixis (flapping tremor). Symptomatic involvement of the basal ganglia manifesting as choreoathetosis and clinical and radiological resolution with hemodialysis has been reported in the medical literature, but only rarely. The present report details such a case.

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“…In our article, 1 we tried to evaluate the specific MR imaging findings in patients with clinically diagnosed uremic encephalopathy. Therefore, we enrolled 9 of 10 patients with chronic renal failure (CRF) and the lentiform fork sign (LFS) on brain MR imaging and 1 patient with acute renal failure (ARF) without the LFS.…”

mentioning

confidence: 99%