Uremic Encephalopathy Presenting with Unilateral Destructive Leukoencephalopathy Successfully Treated with Hemodialysis

An 81-year-old woman was hospitalized with progressive consciousness disturbance. Blood tests showed acidemia with severe renal dysfunction, and a cerebral spinal fluid (CSF) test showed pleocytosis with myelin basic protein (MBP) elevation. Brain magnetic resonance imaging showed unilaterally domin...

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Bibliographic Details
Published in:Internal Medicine 2023/05/01, Vol.62(9), pp.1351-1353
Main Authors: Sakurai, Kazuki, Ikenouchi, Hajime, Yamamoto, Naoki, Furuta, Kyohei, Ogawa, Ryo, Endo, Kaoru
Format: Article
Language:English
Subjects:
Aged, 80 and over
Brain - diagnostic imaging
Brain - pathology
Case Report
Cerebrospinal fluid
Consciousness
Encephalopathy
Female
Hemodialysis
Humans
Internal medicine
Leukocytosis
Leukoencephalopathies - complications
Leukoencephalopathies - diagnostic imaging
Leukoencephalopathy
Magnetic resonance imaging
Magnetic Resonance Imaging - methods
Myelin
Myelin basic protein
Nervous System Diseases
Neuroimaging
Pleocytosis
Renal Dialysis
Renal failure
Renal function
Substantia alba
uremic encephalopathy
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Summary:An 81-year-old woman was hospitalized with progressive consciousness disturbance. Blood tests showed acidemia with severe renal dysfunction, and a cerebral spinal fluid (CSF) test showed pleocytosis with myelin basic protein (MBP) elevation. Brain magnetic resonance imaging showed unilaterally dominant subcortical white matter lesions with lentiform fork sign on T2-weighted imaging. After initiating hemodialysis, her consciousness disturbance and white matter lesions improved, suggesting uremic encephalopathy (UE). Unilaterally dominant leukoencephalopathy and high pleocytosis with MBP elevation in CSF are less common than previously identified characteristics of UE. When unilateral leukoencephalopathy occurs in patients with renal failure, UE should be considered.
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.9494-22