Dialysis Disequilibrium Syndrome in Neurosurgical Patient

ABSTRACT

Neurological symptoms may develope when the blood urea nitrogen is lowered too rapidly by hemodialysis. It is known that these symptoms, known as dialysis disequilibrium are associated with cerebral edema. However, the pathogenesis of brain swelling and neurological deterioration after rapid hemodialysis is controversial. The reverse urea hypothesis suggests that hemodialysis removes urea more slowly from the brain than from the plasma, creating an osmotic gradient that results in cerebral edema. The idiogenic osmole hypothesis proposes that an osmotic gradient between brain and plasma develops during rapid dialysis because of newly formed brain osmoles. Authors report a such case and discuss the possible mechanism and preventive methods.