In proportion to a rapid increase of dialysis patient, death caused by neurological complications is increasing annually among long-term hemodialyzed patients. A case of
chronic subdural hematoma during long-term
hemodialysis is presented. A 35-year-old male had undergone
hemodialysis three times weekly for four years. He had marked changes in
body-weight and blood pressure between
hemodialysis. In March 1983, he had a
headache,
vomiting, and left
hemiparesis. The CT scan showed a right
subdural hematoma. He was admitted to our hospital 10 days later because of progressive
hemiparesis and speech disturbance. The neurological examination showed left
hemiparesis with sensory deficit and
dysarthria. The CT scan showed an increase in the size of the
subdural hematoma. Bleeding time was over 10 minutes. A right-sided burr hole was made and altered blood was removed and irrigated. After operation,
headache and weakness rapidly subsided, but the next morning, attacks of convulsion occurred. The CT scan showed the rebleeding in the subdural space. After correcting the level of serum
potassium by
hemodialysis, a right parietal
craniotomy was performed.
Hematoma of about 100 g was removed and the
capsule of the
hematoma showed organized tissue histologically. Postoperatively, although attacks of convulsion occurred temporarily, he gradually improved. The levels of serum
potassium and BUN were controlled by several treatments of
hemodialysis. He was discharged with only mild
hemiparesis.
Subdural hematoma caused by
hemodialysis is a very important complication.
Chronic subdural hematoma is sometimes very difficult to differentiate from
dysequilibrium syndrome or dialysis
dementia. The CT scan is a very valuable examination to rule out
subdural hematoma.