혈액투석을 받고있는 환자에서 자발성 뇌출혈

Objective : The cause and clinical outcome of cerebral hemorrhage in patients on maintenance hemodialysis have been poorly studied in korea. The purpose of this paper is to clarify the clincal features and the outcome of cerebral hemorrhage in patients on maintenance hemodialysis. Method : We analyzed clincal features and the outcome of cerebral hemorrhage in 14 patients on maintenance hemodialysis. Hematomas were reviewed and evaluated for location, size, and intraventricular extension by the one of the authors without any prior informations. The axial slice of CT film that the hematoma was appeared in maximal dimension was chosen for evaluations. Result : Hypertension was found in 71.4%(10 cases) and motality rate was 78.5%(11 cases). Basal ganglia hemorrhage was found in 50%(7 cases), subcortex in 28.5%(4 cases), pons in 14.2%(2 cases). Size of hematoma in patients on maintenance hemodialysis was significantly larger than that of hypertensive cerebral hemorrhage patients(p=0.0061). The 4 cases of basal ganglia hemorrhage without intraventricular hemorrhage and subarachnoid hemorrhage were good mental state at the onset of stroke because of small mass effect relative to the size of hematoma. The duration of hemodialysis treatment prior to strokes ranged from 1 to 107 months. Strokes developed within 6 hours of the previous hemodialysis are 5 cases. Average serum albumin concentration was 3.4g/dl. The use of heparin is less responsible for the development of cerebral hemorrhage in patients on maintenance hemodialysis Conclusion : Cerebral hemorrhage in patients on maintenance hemodialysis is more severe in terms of hematoma size and clinical outcome. Therefore, the prevention and treatment of cerebral hemorrhage in patients on maintenance hemodialysis should be more aggressive.