Consciousness disorder after dialysis initiation following head injury with atypical MRI results: a case report

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  • 頭部外傷直後に透析を開始し, MRIにて脳梁の腫脹性病変を認めた1例
  • 症例報告 頭部外傷直後に透析を開始し,MRIにて脳梁の腫脹性病変を認めた1例
  • ショウレイ ホウコク トウブ ガイショウ チョクゴ ニ トウセキ オ カイシ シ,MRI ニテ ノウリョウ ノ シュチョウセイ ビョウヘン オ ミトメタ 1レイ

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<p>Head injury is known to induce brain edema and dialysis initiation can also cause brain edema. Furthermore, it is possible for patients with head injuries to simultaneously start dialysis. However, there are few reports referencing MRI results. We report the case of a 48-year-old man. He was about to start dialysis due to diabetic nephropathy. He injured his head, and on the following day, his consciousness level deteriorated despite improvement on head CT. As uremia was suspected, dialysis was started that day, but on day 3, his consciousness level worsened. We changed intermittent hemodialysis to continuous hemodiafiltration (CHDF) because we suspected dialysis disequilibrium syndrome (DDS). On day 4, head MRI was performed and the bilateral corpus callosum was markedly swollen. We considered several diagnoses, including trauma, stroke, infectious disease, and metabolic encephalopathy, but we noted that his symptom resembled DDS due to head trauma and poor general condition. The corpus callosum edema observed on MRI gradually improved with time and his consciousness level returned to normal. When he left the hospital, his consciousness level was JCS 0.</p>

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