Death caused by brain herniation during hemodialysis

Area of Science:

• Nephrology
• Neurology
• Pathology

Background:

• Brain edema and herniation are known complications of dialysis.
• Previous reports often involved patients with pre-existing central nervous system (CNS) lesions.
• The etiology of dialysis-induced brain edema, particularly in initial treatments, requires further investigation.

Observation:

• An 18-year-old male with renal failure experienced symptoms of brain herniation during his first hemodialysis session.
• Despite supportive care, the patient was declared brain dead and passed away two days later.
• Autopsy confirmed severe brain edema with uncal and cerebellar tonsillar herniation.

Findings:

• The autopsy revealed no coexisting pathological CNS lesions that could have contributed to the brain herniation.
• This case strongly suggests that hemodialysis itself can precipitate brain edema and herniation.

Implications:

• Highlights the critical risk of brain herniation during initial hemodialysis, even in the absence of other CNS pathologies.
• Underscores the need for careful monitoring and potential pre-dialysis interventions in susceptible patients.
• Emphasizes the importance of considering dialysis-induced brain edema as a primary diagnosis in patients presenting with neurological decline post-initiation of renal replacement therapy.