Expressive aphasia in a hemodialysis patient? What does one think of as a differential diagnosis?
1. Rule out Stroke/TIA.
3. Dialysis associated dementia
4. Aluminium toxicity
5. Micro bubbles associated injury
CNS injury in dialysis can be from multiple causes: uremia, anemia, electrolytes, acid base, drugs, trace elements, aluminium, dialysis disequilibrium, impaired cerebral circulation and hypertension.
Lets discuss the last 3 a little bit more in detail. What is Dialysis associated dementia? This was a syndrome that was first described in 1972 which was also called dialysis encephalopathy and can occur as early as 15 months on dialysis to as long as seven years. Interestingly, the first sign of presentation is a speech disorder:- stuttering or slurring of speech- can even be mutism. Agitation and hallucinations are not uncommon. Usually, the stroke workup, lumbar puncture and metabolic workup is negative. Usually, the symptoms are intermittent with worse at the end of dialysis. EEG maybe abnormal showing some high voltage theta and delta waves after dialysis.
This is different from dialysis disequilibrium syndrome. Dialysis dialysis or transplantatation doesn't change the course of the dementia. Later literature on this suggests that this might be a variant of vascular dementia or a combination of alzheimer and vascular dementia.
Some studies might link dementia as above to aluminium toxicity and perhaps that might be the case as the symptoms of aluminium toxicity are also similar.
Microbubbles have been detected in dialysis patients. These originate in extracorpeal lines and tubing of hemodialysis machine and circulate in the blood stream until they lodge perhaps in a organ. Air emboli can lead to some CNS changes and eventually dementia in HD population. 2-5% of physiologic right to left shunt can allow the mircobubbles to get to the brain and if someone has a PFO, even more.
Besides acute events, there are other factors in ESRD patients that can lead to expressive aphasia.
- ► 2018 (57)
- ► 2017 (52)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- ► 2012 (201)
- In the News: Initial access type in dialysis patie...
- In the News: ESA dose responsiveness? Some thought...
- Topic Discussion: H1N1 vaccine in Transplantation
- ASN Abstracts 2011 online
- Topic Discussion: Re transplantation after BK Neph...
- CLINICAL CASE 45: Answers and Summary
- ANIO event at ASN 2011
- CONSULT ROUNDS: Expressive Aphasia in ESRD
- Topic Discussion: TIM molecules and Kidney Transpl...
- HHV-8 in Transplantation
- Patient Perspective: Give us the Choice by Kamal S...
- Hypokalemia quiz answer
- New York Academy of Medicine Nephrology Lecture:- ...
- ASN Podcast :Kidney Research National Dialogue Pod...
- Podocyte Disorders
- Hemodialysis Patients and and their Risky Weekends...
- Congress of Nephrology in Internet 2011
- Gray's Anatomy Classic Collectors Edition : The Ki...
- IN THE News: A report about inducing tolerance in ...
- "Hyponatremia" not that benign
- CONSULT ROUNDS: Hypokalemia and Osmotic Demyelinat...
- In the News:- TOLL like receptors and Nobel Prize ...
- NSLIJ Transplant Surgeon on ABC
- CLINICAL CASE 44: ANSWERS AND SUMMARY
- ▼ October (24)
- ► 2010 (461)