Fujisaki Kiichiro, Nakagawa Kaneyasu, Nagae Hiroshi, Nakano Toshiaki, Taniguchi Masatomo, Masutani Kosuke, Kitazono Takanari, Tsuruya Kazuhiko
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Integrated Therapy for Chronic Kidney Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Case Rep Med. 2017;2017:9265315. doi: 10.1155/2017/9265315. Epub 2017 May 3.
A 66-year-old man with severe renal insufficiency presented with mild confusion associated with uremia. Cranial magnetic resonance imaging (MRI) showed no remarkable changes. The patient was placed on short-duration hemodialysis (2 hours) with smaller surface area and low blood flow (100 mL/min) to avoid dialysis disequilibrium syndrome (DDS). His consciousness gradually improved and he did not develop apparent DDS symptoms. However, T2-weighted FLAIR MRI showed increased signal intensities bilaterally in the cortical and subcortical areas of the occipital lobe on day 15. In other words, cranial MRI showed cerebral edema, indicating asymptomatic DDS. On day 29, cranial MRI showed a return to findings on admission. In this case, because the patient did not have apparent DDS symptoms despite MRI changes, we diagnosed asymptomatic cerebral edema. The patient was discharged on regular intermittent HD without any neurological deficits. No further neurological disturbances were noted during 1-year follow-up. MRI findings in ESKD patients without DDS symptoms help to clarify the diagnosis of cerebral edema. In this case, the patient did not have apparent DDS symptoms and was therefore diagnosed with asymptomatic cerebral edema.
一名66岁的严重肾功能不全男性患者因尿毒症出现轻度意识模糊。头颅磁共振成像（MRI）未显示明显变化。为避免透析失衡综合征（DDS），该患者接受了短时间（2小时）、小表面积和低血流量（100毫升/分钟）的血液透析。他的意识逐渐改善，未出现明显的DDS症状。然而，在第15天，T2加权液体衰减反转恢复（FLAIR）MRI显示双侧枕叶皮质和皮质下区域信号强度增加。换句话说，头颅MRI显示脑水肿，提示无症状性DDS。在第29天，头颅MRI显示恢复至入院时的表现。在该病例中，尽管MRI有变化，但患者没有明显的DDS症状，因此我们诊断为无症状性脑水肿。该患者接受定期间歇性血液透析出院，无任何神经功能缺损。在1年的随访期间未发现进一步的神经功能障碍。无DDS症状的终末期肾病（ESKD）患者的MRI表现有助于明确脑水肿的诊断。在该病例中，患者没有明显的DDS症状，因此被诊断为无症状性脑水肿。
