Peripheral Hemodialysis Shunt With Intracranial Venous Congestion

Author:

Hartmann Andreas1,Mast Henning1,Stapf Christian1,Koch Hans-Christian1,Marx Peter1

Affiliation:

1. From the Departments of Neurology, Stroke Unit (A.H., C.S., P.M.), and Radiology (H-C.K.), Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, and Department of Neurology, Stroke Unit, Berufsgenossenschaftliche Kliniken der Stadt Halle Bergmannstrost, Halle (H.M.), Germany.

Abstract

Background Intracranial venous congestion is often caused by local venous thrombosis or brain arteriovenous fistulas. Hemodialysis shunts are known to cause venous enlargement in the arm or chest but have not been related to intracranial vascular pathology. Case Description A 59-year-old woman who presented with increasing headache, gait instability, and memory loss was a renal transplant recipient who still carried a left upper arm shunt. Cranial CT scan showed enlarged veins in the posterior fossa with incipient hydrocephalus. Extracranial duplex sonography revealed reversed flow in the left internal jugular vein, which normalized on cuff inflation around the shunt-carrying arm. The reversed flow, intracranial venous congestion, and neurological status improved after surgical shunt ligation. Conclusions To our knowledge, this is the first case description of an intracranial venous outflow obstruction caused by a peripheral arteriovenous shunt.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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