Acute massive cerebral infarctions treated with hemodialysis.
We report here a 19-year-old woman with Down syndrome and end-stage renal disease who presented with left-sided weakness and fever. She had a massive pericardial effusion of unclear origin that required daily hemodialysis (HD) and cardiac intervention. She developed an acute right middle cerebral artery infarction with severe edema; her cerebral edema significantly improved with daily HD. Later in her hospitalization, she developed seizures and new onset of multiple acute embolic infarctions in left middle cerebral artery, left anterior cerebral artery (ACA), and right posterior cerebral artery (PCA) distributions with midline shift. However, we again noticed a dramatic decrease in cerebral edema with frequent HD. Although there is controversy about the use of dialysis in patients with stroke, our case suggests that daily HD may provide an alternate strategy for treating massive cerebral infarction. More studies are needed in these patients.
Panichpisal
Kessarin
K
Department of Neurology, State University of New York, Downstate Medical Center, Brooklyn, New York 11203, USA. kessarin100@hotmail.com
Saigusa
Takamitsu
T
Sehli
Sharmila
S
Nugent
Kenneth
K
Yim
Jeremiah H C
JH
D001037:Aphasia / Q000209:etiology; D001810:Blood Volume / Q000502:physiology; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D001929:Brain Edema / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D018450:Disease Progression; D004314:Down Syndrome / Q000150:complications* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D006423:Hemianopsia / Q000209:etiology; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D020766:Intracranial Embolism / Q000209:etiology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D010490:Pericardial Effusion / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006435:Renal Dialysis / Q000379:methods* / Q000592:standards; D012640:Seizures / Q000209:etiology / Q000503:physiopathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult