Neurological sequelae from brachiocephalic vein stenosis
David W Herzig1, Andrew B Stemer, Randy S Bell
1Department of Neurosurgery, Georgetown University Hospital, Washington, DC 20007, USA. david.herzig@gmail.com
Journal of Neurosurgery
|February 5, 2013
Summary
Central venous stenosis, common in hemodialysis patients, can rarely cause neurological issues like subarachnoid hemorrhage and epilepsy. Prompt diagnosis and endovascular treatment are key for recovery.
Area of Science:
- Neurology
- Vascular Surgery
- Nephrology
Background:
- Central venous stenosis, particularly of the brachiocephalic vein (BCV) and superior vena cava, affects 30% of hemodialysis patients.
- Intracranial complications from central venous stenosis are rare, with limited documented cases.
Observation:
- Two cases of brachiocephalic vein stenosis in hemodialysis patients presenting with unusual neurological symptoms are detailed.
- Case 1: A 73-year-old man developed perimesencephalic subarachnoid hemorrhage and seizures secondary to left BCV occlusion.
- Case 2: A 67-year-old woman experienced myoclonic epilepsy and weakness due to left BCV stenosis, initially treated with angioplasty and stenting.
Findings:
- Cerebral angiography revealed venous congestion and reflux, but no primary vascular malformations in both cases.
- Left BCV occlusion in Case 1 required surgical ligation, while BCV stenosis in Case 2 was treated with angioplasty and stenting, with a later stent re-occlusion requiring repeat intervention.
- Both patients experienced resolution of neurological symptoms following interventions addressing the central venous stenosis.
Implications:
- This study highlights that central venous stenosis, though common in hemodialysis, can manifest with severe neurological deficits.
- Early recognition of neurological symptoms in hemodialysis patients with central venous stenosis is crucial.
- Endovascular interventions, including angioplasty and stenting, can effectively manage BCV stenosis and resolve associated neurological complications, improving patient outcomes.
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