Intracerebral hemorrhage from venous HTN in a dialysis patie
The present case has been reported in the journal Neurology.

A 56-year-old woman on hemodialysis through left arm arteriovenous fistula presented with headache, aphasia, and gradually worsening left facial swelling. MRI showed left temporal intracerebral hemorrhage with arterialized veins.

Cerebral angiography revealed multiple areas of venous flow reversal suggesting venous hypertension (figure 2C). Fistulogram demonstrated chronic left cephalic vein occlusion with outflow retrograde through the left internal jugular, facial, intracranial, and then centrally through right internal jugular veins. Recanalization of the venous occlusion improved facial swelling.

Key takeaway:-
Early recognition of facial swelling may prevent intracerebral hemorrhage in patients with arteriovenous fistula.


Source: http://n.neurology.org/content/92/5/e521
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