Hemodialysis-associated acute subdural hematoma. Interim management with peritoneal dialysis

Subdural hematoma is an infrequent occurrence in association with hemodialysis. Because of its rarity, there is no widely accepted method of continuing dialysis in such patients. We describe a case of an interhemispheric subdural hematoma with apparent onset during hemodialysis, after which the patient was successfully managed with peritoneal dialysis for 7 weeks. Following this, hemodialysis was reinstated without recurrent intracranial hemorrhage. The strategy of prompt institution of peritoneal dialysis appears to be useful, and deserves serious consideration for long-term use in patients with subdural hematomas in light of the past record of high mortality with continued hemodialysis. However, it also appears that hemodialysis may be cautiously resumed after an appropriate interval of avoiding anticoagulation.