Papilledema associated with dialysis disequilibrium syndrome

The purpose of this paper is to report a case of dialysis disequilibrium syndrome as an unusual cause of papilledema. A 38-year-old woman with type 1 diabetes mellitus presented with decreased visual acuity and bilateral optic nerve swelling associated with systemic signs and symptoms of dialysis disequilibrium syndrome. Repeated lumbar punctures revealed elevated intracranial pressures. She was placed on acetazolamide with some improvement in symptoms. After renal transplantation, the patient had complete resolution of headaches, nausea and the papilledema. Our conclusion is that patients with visual disturbance and focal neurological symptoms during and after hemodialysis should be suspected of having dialysis disequilibrium syndrome (DDS). DDS is thought to occur as a result of a rapid reduction in plasma osmolality during dialysis. As the shift of urea from cerebral spinal fluid (CSF) is delayed, the relative increase in CSF osmolality draws fluid into the brain. The ensuing cerebral edema is responsible for the characteristic neurological symptoms. We report the association of papilledema with this syndrome, and caution as to the possible concurrent risk of permanent visual impairment.