Transcranial Doppler Monitoring of Dialysis Disequilibrium in an ESRD Patient with Traumatic Brain Injury

  
NCJ_cover.jpgBy Shivani Ghoshal, Jonathan Gomez, Aarti Sarwal

First Online: 24 July 2019

Dialysis disequilibrium syndrome (DDS) is a constellation of signs and symptoms including nausea, headache, seizures, encephalopathy, and even herniation and death [1]. The syndrome is thought to originate from osmolar shifts in dialysis leading to an acute increase in brain water, cerebral edema, and reduced brain compliance [1, 2, 3, 4]. End-stage renal disease (ESRD) patients with new acute neurologic injury involving compromise of the blood–brain barrier may be at particular risk of DDS [4, 5, 6].

Here, we present transcranial Doppler (TCD) images revealing marked intra-dialytic increased distal vascular resistance and compromised flow velocity in ESRD patient with acute traumatic brain injury. Trends in pulsatility indices during hemodialysis may be a useful noninvasive bedside method to monitor for dialysis disequilibrium in ESRD patients with acute neurologic injury.

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