Spontaneous brainstem haemorrhage in a patient with uraemia undergoing initial hemodialysis: A case report

Abstract

The present study reports the case of an elderly male inpatient with uraemia who had a sudden onset of numbness and weakness in the right limbs during sleep at night, accompanied by blurred and double vision, during the induction of haemodialysis (HD). Cranial computed tomography and magnetic resonance imaging revealed signs of brainstem haemorrhage. Consequently, a proactive treatment approach was adopted for decreasing the blood and intracranial pressures of the patient, and regular HD was continued. The condition of the patient improved, and the limbs showed no impairment of sensation, with normal movement. To the best of our knowledge, this is the first reported case of an inpatient with uraemia undergoing HD who developed a sudden brainstem haemorrhage during the induction phase of HD and completely recovered after conservative treatment. This unusual case deserves the attention of all clinicians, who should pay more attention to the patients with spontaneous brainstem hemorrhage.

Keywords: chronic kidney disease; haemodialysis; idiopathic cerebral haemorrhage.

Figure 1

(A) Brain CT on 14th May 2022 showed patchy high density in the brainstem with clear borders, which was considered to be a haemorrhage. (B) Brain CT on 17th May showed patchy high density in the brainstem with clear borders, which was considered to be a haemorrhage slightly increased compared with that of 14th May. (C) Brain CT on 27th May showed patchy high density in the brainstem with clear borders, which indicated that the haemorrhage appeared to be decreasing in extent and had a reduced density compared with that of 17th May. The red arrow shows the haemorrhage site. CT, computed tomography.

Figure 2

Cranial magnetic resonance imaging + magnetic resonance angiography on 31st May showed a piece of (A) short T1 and (B) long T2 dominant mixed signal shadow in the cerebral bridge, surrounded by low signal. (C) fluid attenuated inversion recovery and (D) diffusion-weighted imaging showed high signal locally, and cerebral bridge haematoma was considered. (E and F) The lumen of the M1 segment of the left middle cerebral artery was slightly narrowed, and the posterior cerebral artery was stiffened bilaterally, with uneven lumen thickness and slightly reduced branches, which indicated cerebral arteriosclerosis. The red arrow shows the haemorrhage site.