Hemodialysis graft-induced intracranial hypertension

Innominate vein stenosis causing raised intracranial pressure and blindness

“…To date, there are only 13 reported cases of AV accessinduced intracranial hypertension in the English literature. 1 Central venous stenosis is a common complication seen in end-stage renal disease patients maintained on hemodialysis. Central venous stenosis is usually secondary to previous central venous catheters and the turbulent flow from the AV access.…”

“…The high venous pressure arising from the shunted blood impairs the reabsorption of cerebrospinal fluid across the arachnoid villi, leading to high cerebrospinal fluid pressure. 1 The anatomic requirements for this to occur are as follows. First, the location of the outflow stenosis or occlusion must affect the brachiocephalic vein.…”

“…First, the location of the outflow stenosis or occlusion must affect the brachiocephalic vein. 1 The ipsilateral internal jugular vein must be patent. Finally, in patients with central venous stenosis, the majority of patients will develop a robust network of collaterals through the axillary and subclavian veins.…”

“…Reported cases of reversible vision loss have often been associated with a short duration of symptoms or mild vision loss. 1,5 This emphasizes the importance of early recognition and treatment of this rare and potentially devastating problem.…”

Reversible Encephalopathy Due to Venous Hypertension From Arteriovenous Hemodialysis Graft

“…A review of the literature yielded at least 15 publications reporting neurological signs and symptoms related to venous hypertension caused by altered cervical and cerebral blood flow from central vein access for hemodialysis. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Most of these cases clinically manifested with visual changes and papilledema suggesting a more typical presentation of elevated intracranial pressure, while others presented in a manner similar to our patient with seizures, hemorrhages, ischemic events, and encephalopathy. The time from venous access placement to onset of symptoms was extremely variable, suggesting that this condition needs to be considered in patients with such venous access regardless of when the procedure was performed as long as it is still patent.…”