title: Cerebral microbleeds and cognitive decline in a hemodialysis patient: Case report and review of literature.
abstract: Cerebral microbleeds (CMBs) are small hemosiderin deposits indicative of prior cerebral microscopic hemorrhage and previously thought to be clinically silent. Recent population-based cross-sectional studies and prospective longitudinal cohort studies have revealed association between CMB and cognitive dysfunction. In the general population, CMBs are associated with age, hypertension, and cerebral amyloid angiopathy. In the chronic kidney disease (CKD) population, diminished estimated glomerular filtration rate has been found to be an independent risk factor for CMB, raising the possibility that a uremic milieu may predispose to microbleeds. In the end-stage renal disease (ESRD) population on hemodialysis, the incidence of microbleeds is significantly higher compared with a control group without history of CKD or stroke. We present an ESRD patient on chronic hemodialysis with a history of gradual cognitive decline and progressive CMBs. Through this case and literature review, we illustrate the need to develop detection and prediction models to treat this frequent development in ESRD patients.
authors.affiliation: Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California, U.S.A.
authors.forename: Lin
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Neurology, University of California Irvine School of Medicine, Orange, California, U.S.A.|Departments of Anatomy & Neurobiology and Pathology & Laboratory Medicine, University of California Irvine School of Medicine, Orange, California, U.S.A.
authors.forename: Mark
authors.initials: M
authors.lastname: Fisher
authors.affiliation: Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California, U.S.A.
authors.forename: Wei-Ling
authors.initials: WL
authors.lastname: Lau
authors.affiliation: Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California, U.S.A.
authors.forename: Hamid
authors.initials: H
authors.lastname: Moradi
authors.affiliation: Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California, U.S.A.
authors.forename: Alexander
authors.initials: A
authors.lastname: Cheung
authors.affiliation: Department of Neurology, University of California Irvine School of Medicine, Orange, California, U.S.A.
authors.forename: Gaby
authors.initials: G
authors.lastname: Thai
authors.affiliation: Department of Radiological Sciences, University of California Irvine School of Medicine, Orange, California, U.S.A.
authors.forename: Jason
authors.initials: J
authors.lastname: Handwerker
authors.affiliation: Division of Nephrology and Hypertension, University of California Irvine School of Medicine, Orange, California, U.S.A.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000473:pathology; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D006435:Renal Dialysis / Q000009:adverse effects*; D051436:Renal Insufficiency, Chronic / Q000150:complications*
keywords: Dialysis; cerebral microbleeds; cognitive decline; dementia; uremia