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Open Access Highly Accessed Case report

Dialysis disequilibrium syndrome induced by neoplastic meningitis in a patient receiving maintenance hemodialysis

Yohei Tsuchida1, Takuma Takata1, Toshihiko Ikarashi2, Noriaki Iino3*, Junichiro J Kazama3 and Ichiei Narita3

Author Affiliations

1 Department of Nephrology, Nagaoka Chuo General Hospital, 2041 Kawasaki, Nagaoka, Niigata 940-8653, Japan

2 Department of Pathology, Nagaoka Chuo General Hospital, 2041 Kawasaki, Nagaoka, Niigata 940-8653, Japan

3 Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, Niigata 951-8510, Japan

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BMC Nephrology 2013, 14:255  doi:10.1186/1471-2369-14-255

Published: 18 November 2013

Abstract

Background

Dialysis disequilibrium syndrome is characterized by neurological symptoms resulting from cerebral edema, which occurs as a consequence of hemodialysis. Dialysis disequilibrium syndrome most often occurs in patients who have just started hemodialysis, during hemodialysis, or soon after hemodialysis; although it may also occur in patients who are under maintenance hemodialysis with pre-existing neurological disease.

Case presentation

A 70-year-old woman, who had been receiving maintenance hemodialysis for one year, was diagnosed with ovarian cancer by ascites cytological examination. Two years later, she reported severe headache and nausea during hemodialysis and was diagnosed with dialysis disequilibrium syndrome. Although brain images revealed mild hydrocephalus without any mass lesions, poorly differentiated adenocarcinoma cells were detected in her cerebrospinal fluid. These findings indicated that DDS was induced by neoplastic meningitis due to ovarian cancer metastasis.

Conclusion

Neoplastic meningitis should be considered and excluded in hemodialysis patients with dialysis disequilibrium syndrome and malignancy by cytological examination of the cerebrospinal fluid even if cerebral imaging shows no obvious lesions. This is the first reported case of dialysis disequilibrium syndrome induced by neoplastic meningitis in a patient receiving maintenance hemodialysis.

Keywords:
Dialysis disequilibrium syndrome; Hemodialysis; Neoplastic meningitis