Year: 2012
Type: article
Study design: Case Report
Abstract: Hemodialysis (HD) has been associated with increases in intracranial pressure (ICP).Osmotic shifts occurring during HD are thought to be associated with the development of this phenomenon.• In comatose patients with acute brain injury, an elevation of ICP during HD may be associated with worse cerebral autoregulation.Continuous veno-venous hemofiltration (CVVH) may be a safer alternative in these patients. OYSTER• HD may increase ICP; therefore, caution should be exercised when HD is needed in patients with acute brain injury.CASE REPORT A 59-year-old man with hypertension, type 1 diabetes, and end-stage renal disease on HD presented after head trauma from a fall while walking.Initial neurologic examination showed agitated confusion (E4 M5 V5) and a noncontrast head CT showed a nondepressed linear skull fracture in the right temporal bone with a small amount of subarachnoid hemorrhage in the left superior frontal convexity.On arrival to the neurointensive care unit (NICU), his mental status deteriorated (E1 M4 VT) and a follow-up noncontrast head CT revealed a new intracerebral hemorrhage (ICH) in the left temporal lobe (4.3 cm ϫ 2.2 cm ϫ 3.5 cm) with surrounding edema (figure 1A).The patient's family opted for maximal medical management.Multimodality monitoring (MMM) including an intracranial pressure (ICP) monitor (Camino, Integra Lifesciences) and a brain oxygen monitor (Licox, Integra Lifesciences) was placed in the left frontal lobe, close to the perihematomal region.HD was performed every other day via a pre-existing left groin arteriovenous fistula with a negative goal fluid balance of 2 L per each 3.5-hour session.Initially, MMM demonstrated a mildly elevated ICP (mean 18.9 Ϯ 7.4 mm Hg) over a wide range of
Source: Neurology
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2162020883