Headache during haemodialysis in a patient with shunt: a cause for concern?

Abstract

SUMMARYA 20-year-old woman with a functioning ventriculoperitoneal (VP) shunt consistently reported unbearable vertex headaches and nausea during the last hour of her haemodialysis (HD) sessions. After one particularly severe episode, which was associated with vomiting, restlessness and blurred vision, her team suspected that she was developing dialysis disequilibrium syndrome. She improved fully on cessation of HD, requiring simple analgaesia only, and continued dialysis three times per week. Several more distressing episodes of nausea and headaches compelled us to give intravenous mannitol during HD, resulting in temporary improvement. Subsequently, shorter and more frequent dialysis sessions along with intravenous mannitol resulted in satisfactory clinical response. BACKGROUND

Dialytic Approach in Hemodialysis (HD) Patients with Hydrocephalus

“…shorter and more frequent dialysis sessions along with intravenous mannitol resulted in satisfactory clinical response [11]. We reported a similar effect of correlation between the increase in intraocular pressure during HD and rate of urea removal manifested by post dialysis urea rebound and suggested to reduce blood flow and thus urea removal rates in HD patients with glaucoma [12].…”

“…Thus, in addition to the surgical procedures, reducing blood flow and urea removal rates and thus possibly the urea gap and the increase in cell brain water may be helpful to prevent and ameliorate symptoms in such patients. this approach may be favorable to using short frequent dialysis as previously reported [11], since the increase in brain cell water may be prevented, and not just stopped after a shorter time of HD.…”