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(Stroke. 2001;32:2945.)
© 2001 American Heart Association, Inc.

Case Reports

Peripheral Hemodialysis Shunt With Intracranial Venous Congestion

Andreas Hartmann, MD; Henning Mast, MD; Christian Stapf, MD; Hans-Christian Koch, MD Peter Marx, MD

From the Departments of Neurology, Stroke Unit (A.H., C.S., P.M.), and Radiology (H-C.K.), Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, and Department of Neurology, Stroke Unit, Berufsgenossenschaftliche Kliniken der Stadt Halle Bergmannstrost, Halle (H.M.), Germany.

Correspondence to Andreas Hartmann, MD, Neurologische Abteilung, Stroke Unit, Universitätsklinikum Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. E-mail ahart{at}zedat.fu-berlin.de

Abstract

Background— Intracranial venous congestion is often caused by local venous thrombosis or brain arteriovenous fistulas. Hemodialysis shunts are known to cause venous enlargement in the arm or chest but have not been related to intracranial vascular pathology.

Case Description— A 59-year-old woman who presented with increasing headache, gait instability, and memory loss was a renal transplant recipient who still carried a left upper arm shunt. Cranial CT scan showed enlarged veins in the posterior fossa with incipient hydrocephalus. Extracranial duplex sonography revealed reversed flow in the left internal jugular vein, which normalized on cuff inflation around the shunt-carrying arm. The reversed flow, intracranial venous congestion, and neurological status improved after surgical shunt ligation.

Conclusions— To our knowledge, this is the first case description of an intracranial venous outflow obstruction caused by a peripheral arteriovenous shunt.

Key Words: arteriovenous shunt, surgical • intracranial thrombosis