Sasaki Nozomi, Hiramatsu Taku, Hasegawa Yoshihito, Sawada Motoshi
Department of Neurosurgery, Matsunami General Hospital, Kasamatsu, Japan.
Surg Neurol Int. 2023 Mar 3;14:79. doi: 10.25259/SNI_108_2023. eCollection 2023.
Although central venous occlusion is sometimes seen in hemodialysis (HD) patients, neurological symptoms due to intracranial venous reflux (IVR) are extremely rare.
We present a case of a 73-year-old woman with cerebral hemorrhage due to IVR associated with HD. She presented with lightheadedness and alexia, and was diagnosed with subcortical hemorrhage. Venography through the arteriovenous graft showed occlusion of the left brachiocephalic vein (BCV) and IVR through the internal jugular vein (IJV). It is extremely rare that IVR occurs and causes neurological symptoms. This is because that there is the presence of a valve in the IJV and the communication between the right and left veins through the anterior jugular vein and thyroid vein. Percutaneous transluminal angioplasty for the left obstructive BCV was performed, but the obstructive lesion was only slightly improved. Hence, shunt ligation was performed.
When IVR is found in HD patients, central veins should be confirmed. Early diagnosis and therapeutic intervention are desirable when neurological symptoms are present.
尽管在血液透析（HD）患者中有时会出现中心静脉闭塞，但颅内静脉回流（IVR）导致的神经症状极为罕见。
我们报告一例73岁女性患者，因与血液透析相关的颅内静脉回流导致脑出血。她出现头晕和失读症，被诊断为皮质下出血。通过动静脉移植物进行的静脉造影显示左头臂静脉（BCV）闭塞，且存在通过颈内静脉（IJV）的颅内静脉回流。颅内静脉回流发生并导致神经症状极为罕见。这是因为颈内静脉存在瓣膜，且左右静脉通过颈前静脉和甲状腺静脉相通。对左头臂静脉阻塞性病变进行了经皮腔内血管成形术，但阻塞性病变仅略有改善。因此，进行了分流结扎术。
当在血液透析患者中发现颅内静脉回流时，应确认中心静脉情况。出现神经症状时，早期诊断和治疗干预是可取的。
