title: Dynamics of a haemodynamic headache: A case report and literature review of headache secondary to flow inversion of the internal jugular vein.
abstract: BACKGROUND
  Haemodialysis arteriovenous fistulas have common local and regional complications, but are rarely associated with neurological symptoms.
  
  
  METHODS
  A 43-year-old woman presented with short acute episodes of unilateral, non-throbbing, severe headache, vertigo and left lateropulsion. She had undergone renal transplantation and had a still-functioning left brachial arteriovenous fistula. No abnormality was detected on neurological examination or on brain parenchymal imaging. Colour Doppler ultrasonography showed a subclavian steal syndrome of the left vertebral artery and reversed flow in the left internal jugular vein. Ligation of the arteriovenous fistula had to be delayed as a result of renal graft dysfunction. Six months later she developed a headache attributed to intracranial hypertension. All symptoms subsided after ligation of the arteriovenous fistula.
  
  
  METHODS
  We identified 16 case reports of central neurological complications attributed to haemodialysis brachial fistulas. Headache descriptions were scarce and were not fully detailed.
  
  
  CONCLUSIONS
  The case of our patient suggests that unilateral, episodic, non-throbbing, non-postural headache with transient neurological symptoms can be caused by combined arterial and venous flow abnormalities secondary to a high-flow arteriovenous brachial fistula. In this setting, this pattern of headache may precede overt signs of intracranial hypertension and may be used as a warning sign of cerebral venous congestion.
authors.affiliation: Neurology Department, Hospital Garcia de Orta, Almada, Portugal lipereira@yahoo.com.
authors.forename: Liliana
authors.initials: L
authors.lastname: Pereira
authors.affiliation: Neurology Department, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Elisa
authors.initials: E
authors.lastname: Campos Costa
authors.affiliation: Neuroradiology Department, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Nunes
authors.affiliation: Neuroradiology Department, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Saraiva
authors.affiliation: Nephrology Department, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Joel
authors.initials: J
authors.lastname: Ferreira
authors.affiliation: Nephrology Department, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Cruz
authors.affiliation: Neurology Department, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Miguel
authors.initials: M
authors.lastname: Rodrigues
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000150:complications* / Q000000981:diagnostic imaging*; D001783:Blood Flow Velocity / Q000502:physiology; D001916:Brachial Artery / Q000000981:diagnostic imaging*; D005260:Female; D006261:Headache / Q000000981:diagnostic imaging* / Q000209:etiology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007601:Jugular Veins / Q000000981:diagnostic imaging*; D018615:Ultrasonography, Doppler, Color
keywords: Unilateral headache; arteriovenous fistula; internal jugular vein flow inversion; intracranial hypertension; renal failure