Uremic encephalopathy

Case contributed by Dr Ahmed Abdrabou

Presentation

The patient was found in his home unconscious. His medical history was positive for chronic liver disease and chronic renal failure.

Patient Data

Age: 75 years
Gender: Male
CT

Bilateral symmetrical hypodensity seen involving the caudate and putamen on both sides.

No signs of hemorrhage or acute infarction.  

MRI

Swelling and abnormal signal intensity of the caudate and lentiform nucei bilaterally with characteristic T2/FLAIR hyperintense white matter signal delineating the basal ganglia giving the appearance of lentiform fork sign

Case Discussion

Untreated acute and chronic renal failure can cause accumulation of urea, uric acid and other metabolites in the blood which may affect the brain. During investigation, it was found that the patient missed his dialysis session twice. His urea and uric acid were elevated and his blood was acidic. Unfortunately, the patient died few hours after hospital admission from severe metabolic acidosis. 

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Case information

rID: 65737
Published: 21st Jan 2019
Last edited: 22nd Jan 2019
Inclusion in quiz mode: Included
Institution: Ain Shams University

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