Neurologic Manifestations



Central nervous system manifestations of ESRD may range from mild changes in mentation to coma, convulsions, and death. The more severe clinical manifestations occur in patients with ad­vanced uremia and are alleviated by the institu­tion of dialysis. In a patient with severe uremic central nervous system manifestations, the initial dialysis treatments should be brief so as to avoid the development of a disequilibrium syndrome, manifested by cerebral edema and worsening neu­rologic findings. Usually after a few dialytic treatments, the patient becomes adapted and no longer manifests this dialysis disequilibrium con­dition. A rare but severe neurologic syndrome may occur in patients maintained on dialysis,called “dialysis dementia.” This dementing syn­drome is also associated with a movement dis­order and has a fatal outcome in the majority of patients. Finally, the presence of arteriosclerosis and hypertension makes the ESRD patient vul­nerable to the development of cerebrovascular disease.

The peripheral nervous system is frequently involved in advanced renal disease and is mani­fest bv a glove-stocking peripheral neuropathy. In some patients, the neuropathy may be quite severe and precludes successful rehabilitation. The in­stitution of dialysis may stabilize the neuropathy, but only rarely is a severe neuropathy reversed. In some patients, the neuropathy may progress de­spite seemingly adequate dialysis.

The development of ESRD may also result in dysfunction of the autonomic nervous system. Clinical manifestations may include abnormali­ties in motility of the gastrointestional tract with the findings of gastroparesis and/or diarrhea, la­bile blood pressure, and intolerance to dialysis. Dialysis generally does not reverse the overt man­ifestations of the autonomic neuropathy.