Uremic Encephalopathy with Atypical Magnetic Resonance Features on Diffusion-Weighted Images

Abstract

Uremic encephalopathy is a well-known disease with typical MR findings including bilateral vasogenic or cytotoxic edema at the cerebral cortex or basal ganglia. Involvement of the basal ganglia has been very rarely reported, typically occurring in uremic-diabetic patients. We recently treated a patient who had non-diabetic uremic encephalopathy with an atypical lesion distribution involving the supratentorial white matter, without cortical or basal ganglia involvement. To the best of our knowledge, this is only the second reported case of non-diabetic uremic encephalopathy with atypical MR findings.

Uremic Encephalopathy: MR Imaging Findings and Clinical Correlation

“…10,11 UE presents 3 patterns of imaging findings: basal ganglia involvement, [12][13][14] cortical or subcortical involvement, 15,16 and white matter involvement. 17,18 Basal ganglia involvement is more common in Asian patients with DM. The LFS in patients with UE often affects Asians (from Taiwan, 12,13 Korea, 13,14,18 Japan 19 ).…”

“…17,18 Basal ganglia involvement is more common in Asian patients with DM. The LFS in patients with UE often affects Asians (from Taiwan, 12,13 Korea, 13,14,18 Japan 19 ). DM may make the basal ganglia more vulnerable to uremic toxins because of endothelial dysfunction in cerebral vessels (vascular autoregulatory dysfunction 20 ), and uremic toxin inhibits mitochondrial function with destruction of the pallidum and putamen.…”

“…21 Cortical involvement is a category of posterior reversible leukoencephalopathy syndrome, 22 and DM does not have a great effect on the involvement. 18 Reversible intracerebral disease entities mediated by vascular autoregulatory dysfunction can be classified into 2 distinct groups: hypertensive encephalopathy and UE. 22 However, posterior reversible encephalopathy syndrome is also seen in the uremic conditions in which endothelial toxins are thought to play a role.…”

Bilateral cytotoxic edema of the centrum semiovale in uremic encephalopathy

“…It has a heterogeneous presentation, most often an acute or subacute onset of neurological symptoms including headaches, seizures, confusion, asterixis, ataxia or motor dysfunction [1]. Magnetic Resonance Imaging (MRI) findings and clinical presentation have led to the description of two variants of UE: a cortical type, closely related to posterior reversible encephalopathy syndrome (PRES), and a basal ganglia (BG) type, occurring most often in diabetics [1,2]. MRI changes consist of reversible vasogenic edema.…”

“…e l s e v i e r . c o m / l o c a t e / j n s by hyperglycemia, susceptibility to microthrombi due to small endarteries and increased BG vulnerability to uremic toxins, while cytotoxic edema might be explained by reductions in oxygen consumption and cellular metabolism alterations due to uremia [2]. …”