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비당뇨병성 말기신부전증 환자에서 양측성 기저핵 병변과 소뇌 병변을 동반한 요독성 뇌병증

Other Titles
 Uremic Encephalopathy Associated with Bilateral Basal Ganglia and Cerebellar Lesion in a Non-diabetic Hemodialysis Patient 
Authors
 심성록  ;  이상훈  ;  장재훈  ;  임재윤  ;  최유경  ;  배기선  ;  박우일  ;  김기중  ;  이경열  ;  박형천  ;  하성규 
Citation
 Korean Journal of Nephrology, Vol.25(6) : 1061-1066, 2006 
Journal Title
 Korean Journal of Nephrology (대한신장학회지) 
ISSN
 1225-0015 
Issue Date
2006
Keywords
Bilateral basal ganglia ; Cerebellar vermis ; Metabolic acidosis ; Non-dia betic ESRD ; Uremic encephalopathy
Abstract
Involvement of central nervous system is a well-known compication in uremic patients. However, development of acute extrapyramidal symptoms with bilateral basal ganglia involvement (acute basal ganglia syndrome), especially in non-diabetic hemodialysis patient is very rare. We report a case of acute basal ganglia syndrome in a non-diabetic hemodialysis patient. A 45-year-old man with autosomal dominant polycystic kidney disease (ADPKD) on chronic hemodialysis treatment for the last 4 years was admitted due to generalized myalgia. On admission, the patient was found to have rhabdomyolysis and intractable metabolic acidosis. Nine days after admission, he suddenly developed dysarthria, lateralizing ataxia, and bradykinesia. Brain MRI demonstrated low and high signals in bilateral basal ganglia and cerebellar vermis in T1-weighted and T2-weighted images, respectively. Intensified hemodialysis treatment combined with general supportive therapy resolved the severe metabolic acidosis and the neurologic manifestations gradually improved. Follow up brain CT scan taken 3 months later showed decreased size of initial low attenuation lesions in bilateral basal ganglia and cerebellar vermis. Although no definite pathophysiology is yet established, severe metabolic disorder is believed to play an important role in development of acute basal ganglia syndrome. Correction of metabolic acidosis and hypoglycemia in our patient lead to improvement in neurologic manifestations and organic brain lesions. Our case suggests that severe metabolic acidosis and hypoglycemia in uremic patient may act as risk factors for acute basal ganglia syndrome even in non-diabetic patient.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Ki Joong(김기중)
Park, Woo Il(박우일)
Park, Hyeong Cheon(박형천) ORCID logo https://orcid.org/0000-0002-1550-0812
Bae, Ki Sun(배기선)
Sim, Soung Rok(심성록)
Lee, Kyung Yul(이경열) ORCID logo https://orcid.org/0000-0001-5585-7739
Lim, Jae Yun(임재윤)
Jahng, Jae Hoon(장재훈)
Ha, Sung Kyu(하성규)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/110842
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