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Hypertensive emergency and seizures during haemodialysis
  1. Shraddha Murali1,
  2. Srinivas Vinayak Shenoy2,
  3. Ravindra Attur Prabhu2 and
  4. Shankar Prasad Nagaraju2
  1. 1Kasturba Medical College Manipal, Manipal, Karnataka, India
  2. 2Department of Nephrology, Kasturba Medical College Manipal, Manipal, Karnataka, India
  1. Correspondence to Dr Shraddha Murali; shraddhamurali{at}yahoo.com

Abstract

Intracranial abscesses are uncommon, serious and life-threatening infections. A brain abscess is caused by inflammation and collection of infected material, coming from local or remote infectious sources. Patients with chronic kidney disease on dialysis are prone to invasive bacterial infections like methicillin-resistant Staphylococcus aureus (MRSA) especially in the presence of central venous catheters or arteriovenous grafts. However, intracranial abscess formation due to MRSA is rare. Here, we present a case of MRSA brain abscess with an atypical clinical presentation in the absence of traditional risk factors.

Intracranial abscesses are uncommon, serious, and life-threatening infections. A Brain abscess is caused by inflammation and collection of infected material, coming from local or remote infectious sources. Patients with chronic kidney disease on dialysis are prone to invasive bacterial infections like methicillin-resistant staphylococcus aureus (MRSA) especially in the presence of central venous catheters or arterio-venous grafts. However intracranial abscess formation due to MRSA is rare. Here we present a case of MRSA brain abscess with an atypical clinical presentation in the absence of traditional risk factors. A 46-year-old male with chronic kidney disease (CKD) secondary to chronic glomerulonephritis, on haemodialysis for 4 years through a left brachio-cephalic AVF developed an episode of generalised tonic-clonic seizures lasting 2 min during his scheduled dialysis session. He reported no complaints before entry to the dialysis. On clinical examination, he was drowsy with the absence of any focal motor deficits. His blood pressure was recorded to be 200/120 mm Hg. He was managed in the intensive care unit with mechanical ventilation, intravenous nitroglycerine for blood pressure control, levetiracetam for seizures and empirical vancomycin. Radiological evaluation showed a brain abscess in the midline involving bosth basi-frontal lobes. After medical optimization, the abscess was drained surgically, and the pus cultured. As culture grew Methicillin Resistant Staphylococcus aureus, he was treated with intravenous vancomycin for 6 weeks. On follow up, the abscess had resolved and the patient recovered without any neurological deficits.

  • chronic renal failure
  • dialysis
  • infection (neurology)
  • neurosurgery

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Footnotes

  • Twitter @shraddha158

  • Contributors The case discussed in this report is of a patient who was attended by SM as an intern in Kasturba Medical College Manipal, under the direct supervision of SVS, Assistant Professor, Department of Nephrology, Kasturba Medical College Manipal. The patient was admitted under the care of RAP, Professor, Department of Nephrology, who also oversaw patient care and treatment. SPN is Professor and Head of Department of Nephrology, Kasturba Medical College, Manipal who consulted in the process of treatment.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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