Uremic parkinsonism with atypical phenotypes and radiologic features

Area of Science:

• Neurology
• Nephrology
• Radiology

Background:

• Uremic encephalopathy (UE) is an acute neurometabolic condition typically associated with reversible basal ganglia lesions.
• The precise pathophysiology and clinical spectrum of UE remain incompletely understood.

Observation:

• Two patients presented with a relapsing and worsening course of uremic encephalopathy.
• Atypical features included parkinsonism, paroxysmal dystonic head tremor, and acute lower extremity monoparesis.

Findings:

• Unusual radiological findings revealed combined basal ganglia and cortical lesions.
• Persistent hemorrhagic transformation and focal ischemic lesions in the internal capsule were noted.
• These findings deviate from the typical acute and reversible imaging characteristics of UE.

Implications:

• This case expands the known clinical and radiological spectrum of uremic encephalopathy.
• Suggests a possible multifactorial pathogenesis for atypical UE presentations.
• Highlights the need for considering complex neurological involvement in advanced kidney disease.