Abstract Details

Title Rapidly progressive dementia with seizures due to venous hypertension from arteriovenous hemodialysis graft

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-027

Objective N/A

Background Encephalopathy due to uremia and other metabolic derangements, sometimes accompanied by seizures, is a well-described complication in patients with end stage renal disease (ESRD) on hemodialysis. Rarely such patients can develop a rapidly progressive dementia with seizures caused by cerebral venous congestion due to arterial shunting from an upper limb dialysis access arteriovenous fistula (AVF) to the proximal venous system.

Design/Methods N/A

Results A 71 year-old woman with ESRD on hemodialysis via a right forearm AVF with jump graft to the right internal jugular vein (IJV) initially presented with new confusion one month after this jump graft was created. Over the course of the next year she had several hospital admissions for worsening cognition and seizures. One year following graft placement a CT angiogram/venogram showed 1) arterialized flow in a very large R IJV, 2) thrombosis of the proximal L transverse sinus and very small L jugular venous sinus and L IJV, and 3) dilated and tortuous, left greater than right, supra- and infratentorial cerebral venous vessels. Jump graft closure was initially postponed due to significant hemodialysis access concerns. She developed worsening mental status and a left temporal intraparenchymal hemorrhage. Soon thereafter the graft was ligated, after which the patient’s mental status markedly improved over the course of about 3 weeks and radiological follow up with conventional angiogram showed significantly decreased cerebral venous dilation.

Conclusions Venous congestion encephalopathy is a rare complication of upper limb surgical dialysis fistulas. Its clinical picture of rapidly progressive dementia with seizures and intracranial hemorrhage mimics patients with dural AV fistulas. It should be suspected in patients with proximal, high-volume AVF who present with this syndrome and absence of more typical causes of encephalopathy. Evaluation of the cerebral venous system is necessary to make the diagnosis. Treatment of the AV shunting can lead to significant clinical improvement.

Authors/Disclosures
Maria Antonietta Mazzola, MD (Beth Israel Lahey Health) PRESENTER	Dr. Mazzola has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentec.
Anil Ramineni, MD	Dr. Ramineni has nothing to disclose.
Joseph D. Burns, MD (Lahey Hospital and Medical Center)	Dr. Burns has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Elsevier.
David P. Lerner, MD (One Brooklyn Health)	Dr. Lerner has received publishing royalties from a publication relating to health care.

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