Walters R J, Fox N C, Crum W R, Taube D, Thomas D J
Department of Clinical Neurology, St. Mary's Hospital, London, UK.
Nephron. 2001 Feb;87(2):143-7. doi: 10.1159/000045903.
Haemodialysis may cause neurological symptoms ranging from inconvenient feelings of disequilibrium to life-threatening neurological complications. There are animal data to suggest cerebral swelling may accompany haemodialysis and contribute symptomatically to dialysis disequilibrium. However, MR images acquired following haemodialysis often fail to demonstrate evidence of cerebral oedema. We wished to quantify any potential cerebral volume change which is caused by haemodialysis treatment.
Five renal patients and 5 control subjects had a two volumetric T1-weighted MRI scans on the same day. The patients were imaged immediately before and after haemodialysis. None were taking steroids. Precise positional matching (registration) was used to quantify cerebral volume change.
Patients had an increase in cerebral volume following dialysis which averaged 32.8 ml (SE 7.4 ml, 3% brain volume). The change in the controls was 1.4 ml (SE 0.6 ml), p < 0.001. No patient had significant neurological symptoms.
Cerebral oedema developed in the patients following dialysis. There is a good biological model for these observations. Modifications to dialysis may help. Common problems which increase cerebral volume, e.g. acute stroke, require careful appraisal in these patients. These observations need consideration when quantifying atrophy in dialysis patients.
血液透析可能导致从失衡的不适感觉到危及生命的神经并发症等一系列神经症状。有动物数据表明，血液透析可能伴有脑肿胀，并在症状上导致透析失衡。然而，血液透析后获得的磁共振成像（MR）图像往往未能显示脑水肿的证据。我们希望量化血液透析治疗引起的任何潜在脑容量变化。
5名肾病患者和5名对照受试者在同一天进行了两次容积性T1加权磁共振成像扫描。患者在血液透析前后立即进行成像。均未服用类固醇。采用精确的位置匹配（配准）来量化脑容量变化。
患者透析后脑容量增加，平均增加32.8毫升（标准误7.4毫升，占脑容量的3%）。对照组的变化为1.4毫升（标准误0.6毫升），p<0.001。没有患者出现明显的神经症状。
患者透析后出现脑水肿。对于这些观察结果有一个很好的生物学模型。对透析进行调整可能会有所帮助。在这些患者中，增加脑容量的常见问题，如急性中风，需要仔细评估。在量化透析患者的萎缩情况时，需要考虑这些观察结果。
