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Journal of Neurology Neurosurgery and Psychiatry 2002;72:673-674
© 2002 Journal of Neurology Neurosurgery and Psychiatry

LESSON OF THE MONTH

Simultaneous onset of haemorrhagic and ischaemic strokes in a haemodialysis patient

K Toyoda1, Y Kumai1, K Fujii1, T Ando2, S Ibayashi3

1 Stroke Centre, Fukuoka Red Cross Hospital, Fukuoka, Japan
2 Kidney Centre, Fukuoka Red Cross Hospital
3 Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Correspondence to:
Correspondence to:
Dr Kazunori Toyoda, Department of Cerebrovascular Disease, National Kyushu Medical Centre, 1-8-1 Jigyohama, Chuo-Ku, Fukuoka 810-8563, Japan;
k-toyoda{at}mb6.seikyou.ne.jp


ABSTRACT
Primary brain haemorrhage and infarction only very rarely occur simultaneously. A patient with end stage renal disease from diabetic nephropathy suddenly had motor aphasia and horizontal nystagmus soon after finishing haemodialysis. Neuroradiological studies showed a haematoma on the right side of the pons and an infarct in the left frontal lobe with occlusion of the left internal carotid artery. Specific conditions of the haemodialysis—including anticoagulant use, relative hypovolaemia and hypertension just before haemodialysis, and an abrupt decrease in blood pressure during haemodialysis—seemed to be the major reason for the simultaneous onset of dual strokes.

Keywords: cerebrovascular disease; end stage renal disease; haemodynamic infarction






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