Uremic encephalopathy

Case contributed by Anil Kumar Geetha Virupakshappa
Diagnosis almost certain


Headache, vomiting, one episode of convulsions, no fever

Patient Data

Age: 10 years
Gender: Male

Bilateral symmetric T2 and FLAIR hyperintense signals of the caudate and lentiform nuclei with hyperintense white matter surrounding them giving a lentiform fork sign. No evidence of restricted diffusion or hemorrhage. No abnormal enhancement on post contrast study.

Case Discussion

Uremic encephalopathy is an acquired toxic syndrome related to renal dysfunction. Disturbances in blood brain barrier results in alterations in water transport and brain edema. Subcortical grey and white matter, thalami and midbrain are particularly vulnerable.

Patient's renal parameters reveal elevated serum creatinine levels of 82micro mol/L amounting to stage 1 acute kidney injury.

CSF examination, blood culture, serology, liver function tests, blood sugars and electrolytes were normal.

Urine examination for toxins screen was also negative.

The patient received dialysis with symptomatic improvement.

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