Attur Ravindra Prabhu, Kandavar Ramprasad, Kadavigere Rajagopal, Baig Waqas Wahid
Department of Nephrology, Kasturba Medical Medical College, Manipal, Karnataka, India.
Hemodial Int. 2008 Jul;12(3):313-5. doi: 10.1111/j.1542-4758.2008.00272.x.
We report a patient suffering from chronic kidney disease who presented to us with severe pulmonary edema. His clinical, laboratory, and sonological parameters were suggestive of end-stage renal disease. Hemodialysis was initiated, and after 48 hours (3 sessions of hemodialysis) he became drowsy and a neurological examination revealed left upper limb monoplegia with left facial palsy. Urgent computerized tomography scan of the brain revealed diffuse hypodensity in the cerebral white matter bilaterally, and brain magnetic resonance imaging showed diffuse hyperintensity in the cerebral white matter bilaterally, right internal capsule and external capsule on fluid attenuated inversion recovery and T2 sequences (hypointense on T1 sequence). He made a gradual but complete neurological recovery and was discharged 2 weeks later with normal neurological status. A repeat brain magnetic resonance imaging on follow-up 6 weeks later revealed complete resolution of the white matter abnormalities.
我们报告了一名患有慢性肾脏病的患者，他因严重肺水肿前来就诊。其临床、实验室及超声检查参数提示为终末期肾病。遂开始进行血液透析，48小时后（3次血液透析治疗），他出现嗜睡，神经系统检查发现左侧上肢单瘫伴左侧面瘫。紧急脑部计算机断层扫描显示双侧脑白质弥漫性低密度影，脑部磁共振成像显示在液体衰减反转恢复序列和T2序列上双侧脑白质、右侧内囊和外囊弥漫性高信号（T1序列呈低信号）。他的神经功能逐渐但完全恢复，2周后出院，神经状态正常。6周后随访时重复脑部磁共振成像显示白质异常完全消失。
