Recurrent reversible neurologic deficits during hemodialysis

Area of Science:

• Nephrology
• Neurology
• Vascular Medicine

Background:

• Acute neurological complications can arise in dialysis patients from comorbid conditions or the dialysis process itself.
• Hemodialysis involves significant fluid shifts and hemodynamic changes that can impact cerebral perfusion.

Observation:

• A patient undergoing incident hemodialysis experienced recurrent transient ischemic attacks (TIAs) exclusively during dialysis sessions.
• Symptoms resolved upon cessation of hemodialysis, indicating a procedural link.
• Diagnostic work-up revealed a near-complete occlusion of the left internal carotid artery.

Findings:

• The patient's TIAs were likely caused by a combination of reduced cerebral blood flow during hemodialysis and severe internal carotid artery stenosis.
• The stenotic lesion was surgically inoperable.

Implications:

• This case highlights the critical importance of assessing cerebrovascular status in dialysis patients, particularly those with risk factors.
• Alternative dialysis modalities, such as peritoneal dialysis, may be safer for patients with significant carotid artery disease.
• Understanding the interplay between dialysis-induced hemodynamic changes and underlying vascular pathology is crucial for preventing neurological events.