Repeated Paradoxical Brain Infarctions in a Patient on Self-Managed Home Hemodialysis Using a Long-Term Indwelling Catheter

Takuya Kiyohara, Tadataka Mizoguchi, Junya Kuroda, Yoshinobu Wakisaka, Aya Irie, Chie Kitaoka, Kiichiro Fujisaki, Udai Nakamura, Kazuhiko Tsuruya, Takanari Kitazono, Tetsuro Ago

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Abstract

We describe the case of a 51-year-old Japanese man with an end-stage kidney disease caused by a 30-year history of type 1 diabetes mellitus. The patient had suffered repeated bilateral multiple brain infarctions within a short period of time after the initiation of a self-managed daily home hemodialysis regimen using a long-term indwelling catheter inserted into the right atrium. Despite extensive examinations, we could not find any embolic causes except for the catheter and a patent foramen ovale (PFO). The patient had experienced repeated brain infarctions under antiplatelet and anticoagulation therapies, but suffered no further brain infarctions after the removal of the catheter and the alteration of vascular access from the catheter to an arteriovenous fistula in the forearm. We speculate that the indwelling catheter-associated thrombi or air and the right-to-left shunt through the PFO may have caused the repeated paradoxical brain embolisms in this patient.

Original languageEnglish
Pages (from-to)e183-e185
JournalJournal of Stroke and Cerebrovascular Diseases
Volume26
Issue number9
DOIs
Publication statusPublished - Sep 2017

Fingerprint

Home Hemodialysis
Brain Infarction
Indwelling Catheters
Patent Foramen Ovale
Catheters
Paradoxical Embolism
Intracranial Embolism
Vascular Access Devices
Arteriovenous Fistula
Heart Atria
Type 1 Diabetes Mellitus
Forearm
Chronic Kidney Failure
Thrombosis
Air
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Repeated Paradoxical Brain Infarctions in a Patient on Self-Managed Home Hemodialysis Using a Long-Term Indwelling Catheter. / Kiyohara, Takuya; Mizoguchi, Tadataka; Kuroda, Junya; Wakisaka, Yoshinobu; Irie, Aya; Kitaoka, Chie; Fujisaki, Kiichiro; Nakamura, Udai; Tsuruya, Kazuhiko; Kitazono, Takanari; Ago, Tetsuro.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 26, No. 9, 09.2017, p. e183-e185.

Research output: Contribution to journalArticle

Kiyohara, Takuya ; Mizoguchi, Tadataka ; Kuroda, Junya ; Wakisaka, Yoshinobu ; Irie, Aya ; Kitaoka, Chie ; Fujisaki, Kiichiro ; Nakamura, Udai ; Tsuruya, Kazuhiko ; Kitazono, Takanari ; Ago, Tetsuro. / Repeated Paradoxical Brain Infarctions in a Patient on Self-Managed Home Hemodialysis Using a Long-Term Indwelling Catheter. In: Journal of Stroke and Cerebrovascular Diseases. 2017 ; Vol. 26, No. 9. pp. e183-e185.
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