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Pressure changes within a chronic subdural hematoma during hemodialysis
T A Kopitnik1, R de Andrade, M A Gold
1West Virginia University Health Sciences Center, Department of Neurosurgery, Morgantown.
Surgical Neurology
|October 1, 1989
Summary
Spontaneous intracranial hemorrhage during hemodialysis can cause subdural hematoma. This study monitored intracranial pressure, revealing a decrease linked to patient unresponsiveness, similar to low cerebrospinal fluid pressure.
Area of Science:
- Neurosurgery
- Nephrology
- Neurology
Background:
- Spontaneous intracranial hemorrhage is a known complication of systemic anticoagulation therapy, common in hemodialysis patients.
- Neurological symptoms associated with subdural hematoma can mimic those of dialysis disequilibrium syndrome.
- Intracranial pressure monitoring is crucial for understanding neurological changes during hemodialysis.
Observation:
- A patient undergoing hemodialysis experienced neurological decline, becoming unresponsive during treatment.
- Intracranial pressure within a subdural fluid collection was monitored.
- The patient had a history of unresponsiveness during previous dialysis sessions.
Findings:
- Subdural cavity pressure decreased from -10.0 cm H2O pre-dialysis to a minimum of -19.4 cm H2O during hemodialysis.
- Intracranial pressure stabilized at -16.4 cm H2O post-dialysis.
- The patient's neurological unresponsiveness correlated with the minimum intracranial pressure, suggesting a low-pressure syndrome.
Implications:
- This case suggests a syndrome of low intracranial pressure (aliquorrhea) within a subdural hematoma during hemodialysis.
- Unlike previous reports of increased intracranial pressure with hemodialysis, this study highlights a potential low-pressure complication.
- Understanding these pressure dynamics is vital for managing neurological complications in hemodialysis patients with subdural hematomas.