Spontaneous Intracerebral Hemorrhage in the Patients Undergoing Dialysis Therapy

Koo, Sun Ho; Park, Hyung Ki; Kim, Bum Tae; Chang, Jae Chil; Choi, Sun Kwan

Abstract

OBJECTIVE
The management of spontaneous intracerebral hemorrhage in the patients with chronic renal failure is frequently influenced by factors such as coagulopathy, electrolyte imbalance, hemodialysis and malnutrition. This study aimed at evaluating the aggravating factors in the patients with intracerebral hemorrhage and who also underwent dialysis therapy.
METHODS
Eight patients with chronic renal failure and who suffered from intracerebral hemorrhage were investigated. The clinical features, the location and amount of the hematomas, the treatment methods and the hemodialysis patterns were compared.
RESULTS
The locations of hematoma were the subcortex (3 cases), putamen (2 cases), thalamus (2 csaes), and intraventricle (1 case), respectively. The types of dialysis were hemodialysis (6 cases), peritoneal dialysis (1 case), and a continuous form of renal replacement therapy (1 case). The average GCS was 8.4 (range: 5-14). All the patients underwent surgical treatment, which were EVD (3 cases), streotactic hematoma aspiration (2 cases), and decompressive craniectomy with hematoma removal (3 cases). The clinical outcomes were good recovery (1 case), moderate disability (1 case), a vegetative state (1 case) and death (5 cases). For the cases of death, the factors for aggravating the outcome were brain swelling (1 case), rebleeding (2 cases), aspiration pneumonia (1 case), and uncontrolled bleeding during the operation (1 case). The poor outcomes of intracerebral hemorrhage in the dialysis failure patients were caused by poor consciousness during bleeding, (ED note: this word ictus seems to makes no sense here.) and a high risk of rebleeding and brain edema due to anticoagulant and dialysis.
CONCLUSION
We suggest that consideration of the patients' medical problems and an adequate environment for dialysis should be taken into account to achieve favorable patient outcomes.