PMC5434261_01
Cranial MRI on admission. ((a), (b)) Cranial T2-weighted fluid attenuated inversion recovery (FLAIR) MRI showing several old small brain infarctions. (c) Diffusion-weighted MR imaging (DWI) obtained on admission, showing no hyperintense signal alterations. (d) Apparent diffusion coefficient (ADC) mapping obtained on admission, showing no increased diffusion in cerebral lesions.
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T2-weighted fluid attenuated inversion recovery (FLAIR) MRI showed several old, small brain infarcts (Figures 1(a) and 1(b)).
Electroencephalogram taken on admission, showing frequent slow waves (circle).
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EEG showed frequent slow waves, consistent with metabolic encephalopathy (Figure 2).
Clinical course during patient's initiation period. HD, hemodialysis; BUN, blood urea nitrogen; MRI, magnetic resonance imaging. Columns show changes in HD duration. Closed triangles show changes in HD blood flow rate.
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HD (2 hours) with smaller surface area (cellulose triacetate; membrane area: 0.7 m2) and low blood flow (100 mL/min) to avoid DDS (Figure 3). His consciousness gradually improved and he did not develop symptoms of DDS.
Cranial MRI taken on day 15, showing brain edema. ((a), (b)) T2-weighted FLAIR MRI showing increased signal intensities bilaterally in the cortical and subcortical areas of the occipital lobe (arrowhead). (c) DWI demonstrates no hyperintense signal alterations in these regions. (d) ADC is elevated in bilateral occipital lesions (arrowhead).
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T2-weighted FLAIR MRI showed increased signal intensities bilaterally in the cortical and subcortical areas of the occipital lobe (Figures 4(a) and 4(b)). He had no cerebral infarcts, but the ADC was elevated in bilateral occipital lesions (Figures 4(c) and 4(d)).
Brain MRI taken on day 29. ((a), (b)) Cranial T2-weighted FLAIR MRI showing several old small brain infarctions. (c) DWI obtained on day 29, showing no hyperintense signal alterations. (d) ADC mapping obtained on day 29, showing no increased diffusion in cerebral lesions.
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On day 29, a third MRI was performed and showed return to findings on admission (Figure 5).