PMC5376919_01
(a) Computed tomography of the brain upon arrival, showing no evidence of cerebral edema or infarction. (b) Day 3, after 7 hours of continuous renal replacement therapy: the scan now shows generalized cerebral edema with effacement of the basal cisterns and reduced grey-white matter differentiation.
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CT of the abdomen and pelvis revealed an aneurysm of the inferior vena cava as the likely source of the emboli. CT of the brain showed no evidence of cerebral edema or infarction (Figure 1(a)). CRRT was stopped, 50 mL of hypertonic saline (1 mmol/mL) was administered, and the patient was sedated with propofol. CT of the brain was performed and revealed diffuse cerebral edema (Figure 1(b)).
Intracranial pressure during a 13-hour period after start of continuous renal replacement therapy. x-axis denotes time of day. HD = hemodialysis; NICU = Neurointensive Care Unit.
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Approximately seven hours after start of CRRT, ICP had increased to 38 mmHg (Figure 2); the patient had developed diverging eye axes and become unresponsive to pain (Glasgow Coma Score 3).