000 03964nam a22005777a 4500
008 130912s20132013 xxu||||| |||| 00| 0 eng dOvid Technologies
022 _a0022-3085
040 _aOvid MEDLINE(R)
099 _a23373799
245 _aNeurological sequelae from brachiocephalic vein stenosis.
251 _aJournal of Neurosurgery. 118(5):1058-62, 2013 May.
252 _aJ Neurosurg. 118(5):1058-62, 2013 May.
253 _aJournal of neurosurgery
260 _c2013
260 _fFY2013
266 _d2013-09-17
501 _aAvailable online from MWHC library: July 1990 - present, Available in print through MWHC library: 1999 - present
520 _aStenosis 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.
546 _aEnglish
650 _a*Brachiocephalic Veins/pp [Physiopathology]
650 _a*Constriction, Pathologic/co [Complications]
650 _a*Epilepsies, Myoclonic/et [Etiology]
650 _a*Subarachnoid Hemorrhage/et [Etiology]
650 _aAged
650 _aAngioplasty
650 _aBrain Edema/et [Etiology]
650 _aBrain Edema/su [Surgery]
650 _aCentral Nervous System Vascular Malformations/et [Etiology]
650 _aCentral Nervous System Vascular Malformations/su [Surgery]
650 _aConstriction, Pathologic/pp [Physiopathology]
650 _aEpilepsies, Myoclonic/su [Surgery]
650 _aFemale
650 _aHumans
650 _aMale
650 _aNeurosurgical Procedures
650 _aRenal Dialysis/ae [Adverse Effects]
650 _aSubarachnoid Hemorrhage/su [Surgery]
650 _aTreatment Outcome
651 _aMedStar Washington Hospital Center
656 _aRadiology
657 _aCase Reports
657 _aJournal Article
700 _aArmonda, Rocco A
700 _aBank, William O
700 _aBell, Randy S
700 _aLiu, Ai-Hsi
700 _aStemer, Andrew B
790 _aArmonda RA, Bank WO, Bell RS, Herzig DW, Liu AH, Stemer AB
856 _uhttp://dx.doi.org/10.3171/2013.1.JNS121529
_zhttp://dx.doi.org/10.3171/2013.1.JNS121529
942 _cART
_dArticle
999 _c1016
_d1016