A case report with a literature review: cerebral meningioma diagnosed by convulsion and consciousness disorder on initiating hemodialysis

Abstract

Background: Neurological symptoms sometimes occur in hemodialysis patients, with causes including cerebral infarction, cerebral hemorrhaging, meningitis, and encephalitis. Dialysis disequilibrium syndrome (DDS) is widely known as a complication of hemodialysis and is typically encountered in severe uremic patients newly started on hemodialysis. The pathogenesis of DDS is thought to be brain edema that manifests as neurological symptoms, including headache, nausea, confusion, seizures, and coma. However, the relationship between brain tumors and neurological manifestations during hemodialysis is poorly understood. Case presentation: The patient was a 55-year-old man with severe renal dysfunction and uremia symptoms. Blood chemistry showed severe azotemia and acidosis. The patient was placed on short-duration hemodialysis (2 h) with a relatively small surface area, low blood flow (100 mL/min), and intradialytic glycerol infusion to prevent DDS. However, after his first hemodialysis treatment, he complained of disturbed consciousness. We diagnosed his neurological condition as DDS and observed the progress carefully. The next morning, his symptoms had completely resolved, so the patient was started on his second hemodialysis session with the same conditions. However, 2 h after starting the second hemodialysis session, he suffered convulsions accompanied by impaired consciousness. Brain computed tomography (CT) revealed a convexity meningioma and cerebral edema with a midline shift. Before starting the hemodialysis, he had shown no history of seizures, morning headache, or other neurological symptoms. In this case, meningioma was diagnosed based on an increase in the intracranial pressure which occurred after the initiation of hemodialysis. Conclusion: We report this suggestive case to prompt physicians to consider the potential effect of hemodialysis introduction on the brain pressure.

Dialysis Disequilibrium Syndrome in a Patient With Acute Kidney Injury on Chronic Kidney Disease

“…Many fatal cases of DDS have been previously reported [ 2 , 14 - 17 ]. However, some patients have fully recovered from DDS, like our patient [ 18 - 20 ]. This suggests that the prognosis may not be very bad if the patient can tolerate the acute phase; therefore, the patients should be monitored carefully to not miss signs of DDS exacerbation for at least a couple of days after starting HD.…”