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Case No. 751
2026-04-01~2026-04-30
출제자 : 임영희
Hit : 580
| Period | 2026-04-01~2026-04-30 |
|---|---|
| Diagnosis | Uremic encephalopathy |
| Gender |
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| Age | 50 |
| Clinical information | 50/M C.C> Mental change PMHx> CKD on hemodialysis. Lab> Urea Nitrogen 81 mg/dL▲ (5~20) Creatine 11.73 mg/dL▲ (0.69~1.16) ABGA pH 7.265 ▼ (7.350~7.450) HCO3-11.6 mmol/L ▼(22~31) PaCO2 24.2 mmHg ▼(32~48) What is the diagnosis? |
| Discussion | <그림 설명> CT ; Bilateral symmetric low density lesions in the both BG. - with mild swelling. MRI ; FLAIR hyperintensities in bilateral basal ganglia with lentiform fork sign. <해설> Metabolic disorder occurs in acute or chronic renal failure. Likely caused by effects of neurotoxic compounds. Accumulation of uremic toxins such as guanidine compounds (eg, creatinine and guanidine) might stimulate N-methyl-D-aspartate receptors,inhibition of inhibitory γ-aminobutyric acid receptors May be interruption of polysynaptic pathways and alterations in excitatory-inhibitory amino acid balance. Various neurologic symptoms such as movement disorders (tremor, asterixis,myoclonus), cognitive disorders, and mental change <3 Patterns of imaging > 1. Basal ganglia involvement Common in Asians with DM DM ; make basal ganglia more vulnerable to uremic toxins d/t endothelial dysfunction in cerebral vessels. Uremic toxin inhibits mitochondrial function with destruction of pallidum and putamen. 2. Cortical or subcortical involvement Category of PRES Vascular autoregulatory dysfunction. Endothelial toxins play a role in uremic conditions. 3. White matter involvement Rarest form Occurs in supratentorial white matter regions. Considered urea cycle disorder. LFS (lentiform fork sign) T2WI/FLAIR hyperintense rim delineating lateral (external capsule) and medial (internal capsule, internal and external medullary laminae) boundaries of both putamina, resembling a fork. Metabolic acidosis associated with disruption of BBB is essential element in generation of LFS. Differences in metabolic vulnerability between neurons of basal ganglia and astrocytes of surrounding white matter. Reference; Uremic Encephalopathy: MR Imaging Findings and Clinical Correlation, AJNR Am J Neuroradiol, April 28, 2016 |
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