Sudden Coma and Quadriplegia in a Hemodialysis Patient.

Abstract

A 90-year-old man with a 5-year history of ESKD presented with sudden coma and quadriplegia. It turned out that the patient had cut his long-term hemodialysis catheter, and the lumens were exposed directly to air. A 1-minute epileptic myoclonus occurred 7 hours later, and occasional tremors followed. Brain computer tomography showed multiple air emboli in the bilateral brain hemispheres, especially in the right basal ganglia and vessels over the bilateral cerebral surface. Clusters of bubbles were also seen in the superior sagittal sinus (Figure 1). There were emboli in the right internal jugular vein, right brachiocephalic vein, and superior vena cava. Neurologic examination revealed limbs spasticity and diffuse areflexia, yet brainstem reflex was preserved. Hypoxic ischemic encephalopathy was diagnosed. Acute myocardial infraction occurred 1 day later. …