Pilato Fabio, Norata Davide, Rossi Maria Grazia, Di Lazzaro Vincenzo, Calandrelli Rosalinda
Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo Roma, 200, 00128, Italy.
Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo Roma, 200, 00128, Italy.
Behav Brain Res. 2025 Mar 5;480:115393. doi: 10.1016/j.bbr.2024.115393. Epub 2024 Dec 10.
In patients with chronic kidney disease, particularly those in end-stage kidney failure and undergoing dialysis treatment, brain complications may arise, and their potential reversibility mainly hinges on timely diagnosis and intervention. Neurological symptoms may be non-specific ranging from slight or pronounced consciousness disturbance till coma, and imaging is the main tool to guide diagnosis and may reveal the underlying pathophysiological mechanism. Kidney impairment, causing a surge in blood pressure, increases the risk of Posterior Reversible Encephalopathy Syndrome and, leads to neurochemical alterations that result in uremic encephalopathy. In end-stage kidney failure patients, Posterior Reversible Encephalopathy Syndrome predominantly occurs in atypical locations, often involving the bilateral basal ganglia, and exhibit larger volumes compared to patients without kidney dysfunction. Uremic encephalopathy may involve the basal ganglia, white matter, and cortical or subcortical regions; in the latter case, imaging features resemble the typical location of Posterior Reversible Encephalopathy Syndrome. Dialysis Disequilibrium Syndrome, Osmotic Demyelination Syndrome, and Wernicke's encephalopathy are uncommon complications associated with dialysis. Each syndrome manifests distinct imaging patterns: Dialysis Disequilibrium Syndrome shows bilateral, patchy, diffuse white matter alterations; Osmotic Demyelination Syndrome causes central pontine and less often extrapontine lesions (involving bilateral basal ganglia, thalamus, and cerebral peduncles); Wernicke's encephalopathy determines symmetrical abnormalities in the thalamus, mammillary bodies, periaqueductal gray matter, midbrain tectal plate but the nature of brain edema associated with these complications remains controversial. Besides, in rare cases, overlapping imaging features may occur, and only the accurate patient's clinical history reconstruction along with laboratory examination results can lead to a better evaluation of MRI findings and underlying causes allowing prompt therapy.
在慢性肾脏病患者中，尤其是那些处于终末期肾衰竭且正在接受透析治疗的患者，可能会出现脑部并发症，其潜在的可逆性主要取决于及时的诊断和干预。神经症状可能是非特异性的，从轻微或明显的意识障碍到昏迷不等，影像学检查是指导诊断的主要工具，可能揭示潜在的病理生理机制。肾功能损害导致血压升高，增加了后部可逆性脑病综合征的风险，并导致神经化学改变，从而引发尿毒症脑病。在终末期肾衰竭患者中，后部可逆性脑病综合征主要发生在非典型部位，常累及双侧基底节，与无肾功能障碍的患者相比，其体积更大。尿毒症脑病可能累及基底节、白质以及皮质或皮质下区域；在后一种情况下，影像学特征类似于后部可逆性脑病综合征的典型部位。透析失衡综合征、渗透性脱髓鞘综合征和韦尼克脑病是与透析相关的罕见并发症。每种综合征都表现出不同的影像学模式：透析失衡综合征表现为双侧、斑片状、弥漫性白质改变；渗透性脱髓鞘综合征导致脑桥中央以及较少见的脑桥外病变（累及双侧基底节、丘脑和大脑脚）；韦尼克脑病表现为丘脑、乳头体、导水管周围灰质、中脑顶盖的对称性异常，但与这些并发症相关的脑水肿性质仍存在争议。此外，在罕见情况下，可能会出现重叠的影像学特征，只有准确重建患者的临床病史并结合实验室检查结果，才能更好地评估MRI表现及潜在病因，从而实现及时治疗。
