Peripheral hemodialysis shunt with intracranial venous congestion.
BACKGROUND
Intracranial venous congestion is often caused by local venous thrombosis or brain arteriovenous fistulas. Hemodialysis shunts are known to cause venous enlargement in the arm or chest but have not been related to intracranial vascular pathology. Case Description- A 59-year-old woman who presented with increasing headache, gait instability, and memory loss was a renal transplant recipient who still carried a left upper arm shunt. Cranial CT scan showed enlarged veins in the posterior fossa with incipient hydrocephalus. Extracranial duplex sonography revealed reversed flow in the left internal jugular vein, which normalized on cuff inflation around the shunt-carrying arm. The reversed flow, intracranial venous congestion, and neurological status improved after surgical shunt ligation.


CONCLUSIONS
To our knowledge, this is the first case description of an intracranial venous outflow obstruction caused by a peripheral arteriovenous shunt.
Hartmann
A
A
Department of Neurology, Stroke Unit, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Germany. ahart@zedat.fu-berlin.de
Mast
H
H
Stapf
C
C
Koch
H C
HC
Marx
P
P
D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D016121:Brachiocephalic Veins / Q000000981:diagnostic imaging / Q000473:pathology; D002533:Cerebral Angiography; D002550:Cerebral Veins / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D020767:Intracranial Thrombosis / Q000175:diagnosis* / Q000209:etiology*; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D008875:Middle Aged; D011138:Polytetrafluoroethylene / Q000009:adverse effects; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
D011138:Polytetrafluoroethylene