Recurrent reversible neurologic deficits during hemodialysis

Acute neurologic complications in patients receiving dialysis may be secondary to either underlying comorbid diseases, or to the dialysis procedure itself. An incident hemodialysis patient suffered recurrent consecutive episodes of transient ischemic attacks (TIA) that occurred only during hemodialysis and resolved upon discontinuation of the procedure. Eventual work-up demonstrated an almost complete occlusion of left internal carotid artery. It is likely that the decrease in cerebral blood flow that occurs during hemodialysis, in conjunction with the severely stenotic internal carotid artery, explained the patient's symptoms. The stenotic lesion was deemed inoperable. The patient was transferred to peritoneal dialysis and had no further TIA events.