This case report a 59 years-old male in regular dialysis treatment with neurologic emergency characterized by
neurologic signs as deep sopor the cause of which was uremic
encephalopathy. At presentation, laboratory investigations revealed
creatinine 12,75 mg/dl, BUN 174 mg/% and
hyperkalemia 7,5 mq/L. The most common abnormal test results were EEG and ECG. CT brain showed no evidence of hemorrhagic areas or
hematoma subdural. The patient was treated with
hemodialysis and after the first hour of
hemodialysis, laboratory control revealed hypokaliemia with
metabolic acidosis due to arteiovenous
fistula recirculation. After placement of jugular venous
hemodialysis catheter and intensive treatment, the patient showed gradual improvement of uremic
stroke due to
arteriovenous fistula recirculation for high grade venous
stenoses.
Arteriovenous fistula dysfunction remains a major contributor to the morbidity and mortality of
hemodialysis patients. The failure of a newly created AVF to mature and to develop
stenosis in an estabilished AVF are two common clinical predicaments. The goal is to identify a dysfunctional AVF early enough to intervene in a timely manner, either to assist the maturation process or to prevent
thrombosis. Most clinical features of neurologic complications in uremics are nonspecific and do not reliable, but it is important to identify specific causes such as vascular access recirculation for adequate treatment and regression of uremic
stroke.