Is It Possible to Treat "Stroke-Like Symptoms" with Hemodialysis?

OBJECTIVES• To report a unique presentation of stroke-like symptoms and bilateral symmetric basal ganglia hypoattenuation in two diabetic patients with End Stage Renal Disease (ESRD)• To increase the awareness of this entity• To describe the medical management associated with symptomatic improvementCASE REPORTCase1A 52-year-old Hispanic woman presented with 3 weeks of slurred speech, unstable gait, and bilateral (b/l) lower extremity (LE) weakness. Her history included ESRD, type 2 diabetes mellitus (DM2), hypertension (HTN) and hyperlipidemia.The NIHSS on arrival was 5. The stroke team was activated but she did not meet the criteria to receive tissue plasminogen activator (Tpa). A CT of the brain exhibited symmetric hypoattenuation in bilateral lenticular nuclei. Laboratory findings revealed hyperkalemia (7.1mmol/L), normal hepatic panel, prothrombin time (PT), and urine toxicology (Utox). Emergent hemodialysis (HD) was completed after which slurred speech and unstable gait improved.Case2A 43-year-old Hispanic woman presented with 5 days of slurred speech, b/l LE weakness, and imbalance. Her history included ESRD, DM2, and HTN. She had missed two HD sessions.The NIHSS on arrival was 6. The stroke team was activated but she did not meet the criteria to receive Tpa. A brain MRI exhibited abnormal enlargement and signal within bilateral lenticular nuclei. Laboratory findings revealed mild hyperkalemia (5.8 mmol/L), normal hepatic panel, PT, and Utox. She received HD two times in the course of 5 days. The symptoms improved after the second HD session.CONCLUSIONS• Diabetic patients with ESRD on HD can present with stroke-like symptoms associated with bilateral basal ganglia hypoattenuation . This presentation can be confused initially with a stroke.• Brain imaging can assist with making the diagnosis. The clinical presentation in our cases included slurred speech, ataxia, and bilateral lower extremity weakness.• Hemodialysis leaded to clinical improvement. Disclosure: Dr. Rodriguez Alvarez has nothing to disclose. Dr. Pillai has nothing to disclose. Dr. Gomez has nothing to disclose. Dr. Avagyan has nothing to disclose. Dr. Gold has nothing to disclose. Dr. Sternman has nothing to disclose. Dr. Thompson has nothing to disclose.