Left temporal hemorrhage caused by cerebral venous reflux of a brachio-brachial hemodialysis fistula
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SHORT REPORT
Left temporal hemorrhage caused by cerebral venous reflux of a brachio-brachial hemodialysis fistula Jun Haruma 1,2
&
Simon Escalard 1 & Stanislas Smajda 1 & Michel Piotin 1
Received: 19 February 2020 / Accepted: 5 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Central vein disease (CVD) is a well-known complication of central venous cannulations, indwelling dialysis catheters, and arteriovenous grafts. Brachiocephalic vein (BCV) stenosis or thrombotic occlusion can occur in dialysis patients, and the presence of an ipsilateral arteriovenous fistula can cause cerebral venous hypertension due to retrograde flow in the ipsilateral jugular vein. A 53-year-old man receiving hemodialysis (left brachiocephalic hemodialysis fistula) presented with impaired consciousness and seizures related to status epilepticus due to left temporal multifocal hemorrhages. Brain computed tomography and angiogram showed left cortical vein congestion without intracranial arteriovenous shunt. Complementary left brachial angiogram showed a left BCV stenosis and jugular and cerebral high-flow venous reflux with cortical venous reflux from the hemodialysis fistula. The left arm shunt resulted in severe cerebral venous hypertension due to ipsilateral stenosis of the BCV. BCV angioplasty immediately resolved the cerebral reflux. Patients with hemodialysis fistulas are at a higher risk of developing these intracerebral hemorrhage complications. Keywords Intracranial hemorrhage . Brachiocephalic vein stenosis . Endovascular treatment . Venous stenting
Introduction
Case presentation
Central vein disease (CVD) is a well-known complication of central venous cannulations, indwelling dialysis catheters, and arteriovenous grafts [1]. Brachiocephalic vein (BCV) stenosis or thrombotic occlusion can occur in dialysis patients, and the presence of an ipsilateral arteriovenous fistula can cause cerebral venous hypertension due to retrograde flow in the ipsilateral jugular vein [2]. We describe a case in which a BCV stenosis led to retrograde blood flow from the brachio-brachial hemodialysis (HD) fistula into the cerebral venous system. This increased the cerebral venous pressure and consequently resulted in intracerebral hemorrhage (ICH).
A 53-year-old man suffering from end-stage renal disease (ESRD) and receiving HD for 4 years (left brachiocephalic HD fistula) presented with impaired consciousness and seizures related to status epilepticus. He was transferred to an emergency hospital and intubated for status epilepticus. Computed tomography (CT) showed left temporal parenchymal multifocal hemorrhages. After 2 days, CT showed a stable lesion so the patient was extubated. The National Institutes of Health Stroke Scale (NIHSS) score and the Glasgow Coma Scale (GCS) were then evaluated as 10 and 14, respectively, due to aphasia and mild hemiplegia caused by brain edema. The patient’s neurological symptoms gradually improved, and he was transferred to our institution for further investigations. At admission,
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