Neurological sequelae from brachiocephalic vein stenosis.

MedStar author(s):
Citation: Journal of Neurosurgery. 118(5):1058-62, 2013 May.PMID: 23373799Institution: MedStar Washington Hospital CenterDepartment: RadiologyForm of publication: Journal ArticleMedline article type(s): Case Reports | Journal ArticleSubject headings: *Brachiocephalic Veins/pp [Physiopathology] | *Constriction, Pathologic/co [Complications] | *Epilepsies, Myoclonic/et [Etiology] | *Subarachnoid Hemorrhage/et [Etiology] | Aged | Angioplasty | Brain Edema/et [Etiology] | Brain Edema/su [Surgery] | Central Nervous System Vascular Malformations/et [Etiology] | Central Nervous System Vascular Malformations/su [Surgery] | Constriction, Pathologic/pp [Physiopathology] | Epilepsies, Myoclonic/su [Surgery] | Female | Humans | Male | Neurosurgical Procedures | Renal Dialysis/ae [Adverse Effects] | Subarachnoid Hemorrhage/su [Surgery] | Treatment OutcomeYear: 2013Local holdings: Available online from MWHC library: July 1990 - present, Available in print through MWHC library: 1999 - presentISSN:
  • 0022-3085
Name of journal: Journal of neurosurgeryAbstract: Stenosis of central veins (brachiocephalic vein [BCV] and superior vena cava) occurs in 30% of hemodialysis patients, rarely producing intracranial pathology. The authors present the first cases of BCV stenosis causing perimesencephalic subarachnoid hemorrhage and myoclonic epilepsy. In the first case, a 73-year-old man on hemodialysis presented with headache and blurry vision, and was admitted with presumed idiopathic intracranial hypertension after negative CT studies and confirmatory lumbar puncture. The patient mildly improved until hospital Day 3, when he experienced a seizure; emergency CT scans showed perimesencephalic subarachnoid hemorrhage. Cerebral angiography failed to find any vascular abnormality, but demonstrated venous congestion. A fistulogram found left BCV occlusion with jugular reflux. The occlusion could not be reopened percutaneously and required open fistula ligation. Postoperatively, symptoms resolved and the patient remained intact at 7-month follow-up. In the second case, a 67-year-old woman on hemodialysis presented with right arm weakness and myoclonic jerks. Admission MRI revealed subcortical edema and a possible dural arteriovenous fistula. Cerebral angiography showed venous engorgement, but no vascular malformation. A fistulogram found left BCV stenosis with jugular reflux, which was immediately reversed with angioplasty and stent placement. Postprocedure the patient was seizure free, and her strength improved. Seven months later the patient presented in myoclonic status epilepticus, and a fistulogram revealed stent occlusion. Angioplasty successfully reopened the stent and she returned to baseline; she was seizure free at 4-month follow-up. Central venous stenosis is common with hemodialysis, but rarely presents with neurological findings. Prompt recognition and endovascular intervention can restore normal venous drainage and resolve symptoms.All authors: Armonda RA, Bank WO, Bell RS, Herzig DW, Liu AH, Stemer ABFiscal year: FY2013Digital Object Identifier: Date added to catalog: 2013-09-17
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 23373799 Available 23373799

Available online from MWHC library: July 1990 - present, Available in print through MWHC library: 1999 - present

Stenosis of central veins (brachiocephalic vein [BCV] and superior vena cava) occurs in 30% of hemodialysis patients, rarely producing intracranial pathology. The authors present the first cases of BCV stenosis causing perimesencephalic subarachnoid hemorrhage and myoclonic epilepsy. In the first case, a 73-year-old man on hemodialysis presented with headache and blurry vision, and was admitted with presumed idiopathic intracranial hypertension after negative CT studies and confirmatory lumbar puncture. The patient mildly improved until hospital Day 3, when he experienced a seizure; emergency CT scans showed perimesencephalic subarachnoid hemorrhage. Cerebral angiography failed to find any vascular abnormality, but demonstrated venous congestion. A fistulogram found left BCV occlusion with jugular reflux. The occlusion could not be reopened percutaneously and required open fistula ligation. Postoperatively, symptoms resolved and the patient remained intact at 7-month follow-up. In the second case, a 67-year-old woman on hemodialysis presented with right arm weakness and myoclonic jerks. Admission MRI revealed subcortical edema and a possible dural arteriovenous fistula. Cerebral angiography showed venous engorgement, but no vascular malformation. A fistulogram found left BCV stenosis with jugular reflux, which was immediately reversed with angioplasty and stent placement. Postprocedure the patient was seizure free, and her strength improved. Seven months later the patient presented in myoclonic status epilepticus, and a fistulogram revealed stent occlusion. Angioplasty successfully reopened the stent and she returned to baseline; she was seizure free at 4-month follow-up. Central venous stenosis is common with hemodialysis, but rarely presents with neurological findings. Prompt recognition and endovascular intervention can restore normal venous drainage and resolve symptoms.

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