Kidney&Cns

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GENERAL NEUROLOGY

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Kidney&Cns

  1. 1. NEUROLOGICAL DYSFUNCTION IN UREMIA&DIALYSIS Dept. of neurology
  2. 2. • UREMIC ENCEPHALOPATHY • UREMIC NEUROPATHY • OPTIC NEUROPATHY NEUROLOGICAL COMPLICATIONS OF DIALYSIS ENTRAPMENT NEUROPATHY ISCHEMIC NEUROPATHY DIALYSIS DYSEQUILIBRIUM SYNDROME WERNICKE’S ENCEPHALOPATHY DIALYSIS DEMENTIA
  3. 3. UREMIC ENCEPHALOPATHY COMA CAUSES  HYPERTENSIVE ENCEPHALOPATHY  PRES  FLUID&ELECTROLYTE IMBALANCE  SEPSIS  SEIZURES  DIALYSIS  THIAMINE DEF.  DRUG TOXICITY  TRANSPLANT REJECTION
  4. 4. PATHOPHYSIOLOGY • PATHOLOGICAL CHANGES • METABOLIC CHANGES • UREMIC TOXINS • HORMONAL CHANGES
  5. 5. CLINICAL FEATURES • IMPAIRED EXTERNAL AWARENESS • CONCENTRATION • ATTENTION • ORIENTATION • EMOTIONAL &SLEEP CHANGES • MEMORY • OBTUNDATION • DELIRIUM • COMA
  6. 6. CLINICAL FEATURES CONTD • POSTURAL TREMOR • ASTERIXIS • MYOCLONUS • SEIZURES • PARATONIA • PRIMITIVE REFLEXES
  7. 7. INVESTIGATIONS • E/O RENAL DYSFUNCTION • CSF • EEG • IMAGING
  8. 8. TREATMENT OF UREMIC CONVULSIONS • DRUG LEVELS • PHENYTOIN • VALPROIC ACID • PHENOBARBITOL • LEVETIRACETAM,GABAPENTIN,TOPIRAMATE, P REGABALIN
  9. 9. UREMIC NEUROPATHY • GFR<12ml/min-PERIPHERAL NERVE DYSFUNCTION • GFR<6ml/min-CLINICAL DEFICITS PATHOPHYSIOLOGY • MIDDLE MOLECULE THEORY • PARATHYROID HORMONE • UREMIC NEUROTOXIN CRITERIA • HYPERKALEMIA
  10. 10. CLINICAL FEATURES • LENGTH DEPENDENT, SYMMETYRIC ,MIXED SENSORY MOTOR POLY NEUROPATHY • DYSESTHESIAS • MUSCLE CRAMPS • RESTLESS LEG • VIBRATION APPRECIATION • DTR • MOTOR WEAKNESS
  11. 11. NEUROPATHY INVESTIGATIONS • NERVE BIOPSY • NCS • EMG
  12. 12. RESTLESS LEG SYNDROME • WORST AT NIGHT&REST • LOW HB,HIGH PHOSPHOROUS • TREATMENT
  13. 13. TREATMENT • DIALYSIS • RENAL TRNSPLANTATION
  14. 14. AUTONOMIC NEUROPATHY • POSTURAL HYPOTENSION • IMPAIRED SWEATING • IMPOTENCE • GI DISTURBANCES
  15. 15. OPTIC NEUROPATHY • NEUROTOXIC • ISCHAEMIC • DRUGS • ICT
  16. 16. NEUROLOGICAL COMPLICATIONS OF DIALYSIS • MEMORY&ATTENTION • SUBDURAL HEMATOMA • MUSCLE CRAMPS,HEADACHE, NAUSEA, VOMITINGS • CEREBROVASCULAR DISEASE
  17. 17. ENTRAPMENT NEUROPATHY • CARPAL TUNNEL SYNDROME • ULNAR NERVE LESIONS
  18. 18. ISCHEMIC NEUROPATHY • MILD –SENSORY • SEVERE-MOTOR&SENSORY • ISCHEMIC MONOMELIC NEUROPATHY
  19. 19. DIALYSIS DYSEQILIRIUM SYNDROME • HEADACHE • NAUSEA, ANOREXIA • MUSCLE CRAMPS • IRRITABILITY,RESTLESSNESS • AGITATION ,CONFUSION • COMA, SEIZURE • PAPILLEDEMA, RAISED ICP • EXOPHTHOLMOS, RAISED IOP
  20. 20. • REVERSE UREA EFFECT • IDIOGENIC OSMOLES DIFFERENTIALS UREMIC ENCEPHALOPATHY INFECTION HEMORRHAGE CEREBRAL INFARCTION HYPOGLYCEMIA, HYPONATREMIA MANAGEMENT
  21. 21. WERNICK’S ENCEPHALOPATHY • MALNUTRITION • TPN • INFECTIONS • RPT. INFUSIONS OF GLU., INSULIN ATAXIA, OPHTHALMOPLEGIA,CONFUSION
  22. 22. DIALYSIS DEMENTIA • CLINICAL FEATURES • ALUMINIUM CONTAMINATION • PHOSPHATE BINDERS • TAU PROTEIN
  23. 23. TREATMENT • DIAZEPAM • DEFEROXAMINE

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