NEUROLOGICAL DYSFUNCTION IN

UREMIA&DIALYSIS Dept. of neurology

• UREMIC ENCEPHALOPATHY• UREMIC NEUROPATHY• OPTIC NEUROPATHYNEUROLOGICAL COMPLICATIONS OF DIALYSIS ENTRAPMENT NEUROPATHYISCHEMIC NEUROPATHYDIALYSIS DYSEQUILIBRIUM SYNDROMEWERNICKE’S ENCEPHALOPATHYDIALYSIS DEMENTIA

UREMIC ENCEPHALOPATHY

COMA CAUSES HYPERTENSIVE ENCEPHALOPATHY PRES FLUID&ELECTROLYTE IMBALANCE SEPSIS SEIZURES DIALYSIS THIAMINE DEF. DRUG TOXICITY TRANSPLANT REJECTION

PATHOPHYSIOLOGY

• PATHOLOGICAL CHANGES• METABOLIC CHANGES• UREMIC TOXINS• HORMONAL CHANGES

CLINICAL FEATURES

• IMPAIRED EXTERNAL AWARENESS• CONCENTRATION• ATTENTION• ORIENTATION• EMOTIONAL &SLEEP CHANGES• MEMORY• OBTUNDATION • DELIRIUM• COMA

CLINICAL FEATURES CONTD

• POSTURAL TREMOR• ASTERIXIS• MYOCLONUS• SEIZURES• PARATONIA• PRIMITIVE REFLEXES

INVESTIGATIONS

• E/O RENAL DYSFUNCTION• CSF• EEG• IMAGING

TREATMENT OF UREMIC CONVULSIONS

• DRUG LEVELS• PHENYTOIN• VALPROIC ACID• PHENOBARBITOL• LEVETIRACETAM,GABAPENTIN,TOPIRAMATE,

PREGABALIN

UREMIC NEUROPATHY

• GFR<12ml/min-PERIPHERAL NERVE DYSFUNCTION

• GFR<6ml/min-CLINICAL DEFICITS

PATHOPHYSIOLOGY• MIDDLE MOLECULE THEORY• PARATHYROID HORMONE• UREMIC NEUROTOXIN CRITERIA• HYPERKALEMIA

CLINICAL FEATURES

• LENGTH DEPENDENT, SYMMETYRIC ,MIXED SENSORY MOTOR POLY NEUROPATHY

• DYSESTHESIAS• MUSCLE CRAMPS• RESTLESS LEG • VIBRATION APPRECIATION• DTR• MOTOR WEAKNESS

NEUROPATHY INVESTIGATIONS

• NERVE BIOPSY• NCS• EMG

RESTLESS LEG SYNDROME

• WORST AT NIGHT&REST• LOW HB,HIGH PHOSPHOROUS• TREATMENT

TREATMENT

• DIALYSIS• RENAL TRNSPLANTATION

AUTONOMIC NEUROPATHY

• POSTURAL HYPOTENSION• IMPAIRED SWEATING• IMPOTENCE• GI DISTURBANCES

OPTIC NEUROPATHY

• NEUROTOXIC• ISCHAEMIC• DRUGS • ICT

NEUROLOGICAL COMPLICATIONS OF DIALYSIS

• MEMORY&ATTENTION• SUBDURAL HEMATOMA• MUSCLE CRAMPS,HEADACHE, NAUSEA,

VOMITINGS• CEREBROVASCULAR DISEASE

ENTRAPMENT NEUROPATHY

• CARPAL TUNNEL SYNDROME• ULNAR NERVE LESIONS

ISCHEMIC NEUROPATHY

• MILD –SENSORY• SEVERE-MOTOR&SENSORY• ISCHEMIC MONOMELIC NEUROPATHY

DIALYSIS DYSEQILIRIUM SYNDROME

• HEADACHE• NAUSEA, ANOREXIA• MUSCLE CRAMPS• IRRITABILITY,RESTLESSNESS• AGITATION ,CONFUSION• COMA, SEIZURE• PAPILLEDEMA, RAISED ICP• EXOPHTHOLMOS, RAISED IOP

• REVERSE UREA EFFECT• IDIOGENIC OSMOLESDIFFERENTIALSUREMIC ENCEPHALOPATHYINFECTIONHEMORRHAGECEREBRAL INFARCTIONHYPOGLYCEMIA, HYPONATREMIAMANAGEMENT

WERNICK’S ENCEPHALOPATHY

• MALNUTRITION• TPN• INFECTIONS• RPT. INFUSIONS OF GLU., INSULINATAXIA, OPHTHALMOPLEGIA,CONFUSION

DIALYSIS DEMENTIA

• CLINICAL FEATURES• ALUMINIUM CONTAMINATION• PHOSPHATE BINDERS• TAU PROTEIN

TREATMENT

• DIAZEPAM• DEFEROXAMINE