GENERAL NEUROLOGY

1. NEUROLOGICAL
DYSFUNCTION IN
UREMIA&DIALYSIS
Dept. of neurology

2. • UREMIC ENCEPHALOPATHY
• UREMIC NEUROPATHY
• OPTIC NEUROPATHY
NEUROLOGICAL COMPLICATIONS OF DIALYSIS
ENTRAPMENT NEUROPATHY
ISCHEMIC NEUROPATHY
DIALYSIS DYSEQUILIBRIUM SYNDROME
WERNICKE’S ENCEPHALOPATHY
DIALYSIS DEMENTIA

3. UREMIC ENCEPHALOPATHY
COMA CAUSES
 HYPERTENSIVE ENCEPHALOPATHY
 PRES
 FLUID&ELECTROLYTE IMBALANCE
 SEPSIS
 SEIZURES
 DIALYSIS
 THIAMINE DEF.
 DRUG TOXICITY
 TRANSPLANT REJECTION

4. PATHOPHYSIOLOGY
• PATHOLOGICAL CHANGES
• METABOLIC CHANGES
• UREMIC TOXINS
• HORMONAL CHANGES

5. CLINICAL FEATURES
• IMPAIRED EXTERNAL AWARENESS
• CONCENTRATION
• ATTENTION
• ORIENTATION
• EMOTIONAL &SLEEP CHANGES
• MEMORY
• OBTUNDATION
• DELIRIUM
• COMA

6. CLINICAL FEATURES CONTD
• POSTURAL TREMOR
• ASTERIXIS
• MYOCLONUS
• SEIZURES
• PARATONIA
• PRIMITIVE REFLEXES

7. INVESTIGATIONS
• E/O RENAL DYSFUNCTION
• CSF
• EEG
• IMAGING

10. TREATMENT OF UREMIC
CONVULSIONS
• DRUG LEVELS
• PHENYTOIN
• VALPROIC ACID
• PHENOBARBITOL
• LEVETIRACETAM,GABAPENTIN,TOPIRAMATE, P
REGABALIN

11. UREMIC NEUROPATHY
• GFR<12ml/min-PERIPHERAL NERVE
DYSFUNCTION
• GFR<6ml/min-CLINICAL DEFICITS
PATHOPHYSIOLOGY
• MIDDLE MOLECULE THEORY
• PARATHYROID HORMONE
• UREMIC NEUROTOXIN CRITERIA
• HYPERKALEMIA

12. CLINICAL FEATURES
• LENGTH DEPENDENT, SYMMETYRIC ,MIXED
SENSORY MOTOR POLY NEUROPATHY
• DYSESTHESIAS
• MUSCLE CRAMPS
• RESTLESS LEG
• VIBRATION APPRECIATION
• DTR
• MOTOR WEAKNESS

13. NEUROPATHY INVESTIGATIONS
• NERVE BIOPSY
• NCS
• EMG

14. RESTLESS LEG SYNDROME
• WORST AT NIGHT&REST
• LOW HB,HIGH PHOSPHOROUS
• TREATMENT

15. TREATMENT
• DIALYSIS
• RENAL TRNSPLANTATION

16. AUTONOMIC NEUROPATHY
• POSTURAL HYPOTENSION
• IMPAIRED SWEATING
• IMPOTENCE
• GI DISTURBANCES

17. OPTIC NEUROPATHY
• NEUROTOXIC
• ISCHAEMIC
• DRUGS
• ICT

18. NEUROLOGICAL COMPLICATIONS OF
DIALYSIS
• MEMORY&ATTENTION
• SUBDURAL HEMATOMA
• MUSCLE
CRAMPS,HEADACHE, NAUSEA, VOMITINGS
• CEREBROVASCULAR DISEASE

20. ENTRAPMENT NEUROPATHY
• CARPAL TUNNEL SYNDROME
• ULNAR NERVE LESIONS

22. ISCHEMIC NEUROPATHY
• MILD –SENSORY
• SEVERE-MOTOR&SENSORY
• ISCHEMIC MONOMELIC NEUROPATHY

23. DIALYSIS DYSEQILIRIUM SYNDROME
• HEADACHE
• NAUSEA, ANOREXIA
• MUSCLE CRAMPS
• IRRITABILITY,RESTLESSNESS
• AGITATION ,CONFUSION
• COMA, SEIZURE
• PAPILLEDEMA, RAISED ICP
• EXOPHTHOLMOS, RAISED IOP

24. • REVERSE UREA EFFECT
• IDIOGENIC OSMOLES
DIFFERENTIALS
UREMIC ENCEPHALOPATHY
INFECTION
HEMORRHAGE
CEREBRAL INFARCTION
HYPOGLYCEMIA, HYPONATREMIA
MANAGEMENT

25. WERNICK’S ENCEPHALOPATHY
• MALNUTRITION
• TPN
• INFECTIONS
• RPT. INFUSIONS OF GLU., INSULIN
ATAXIA, OPHTHALMOPLEGIA,CONFUSION

26. DIALYSIS DEMENTIA
• CLINICAL FEATURES
• ALUMINIUM CONTAMINATION
• PHOSPHATE BINDERS
• TAU PROTEIN

27. TREATMENT
• DIAZEPAM
• DEFEROXAMINE