A successfully treated case of subarachnoid hemorrhage in a chronic hemodialysis patient

Abstract

We report a case of subarachnoid hemorrhage that occurred in a hemodialysis patient and was successfully treated with hemodiafiltration (HDF) using nafamostat mesilate. A 59-year-old diabetic patient who had been undergoing hemodialysis since January 1992, complained of severe headache on August 11, 1995. Computed tomography (CT) revealed subarachnoid hemorrhage (Hunt grade II). He was treated with strict control of blood pressure which was achieved by intravenous administration of nicardipine, HDF using nafamostat mesilate, and concomitant administration of carbazochrome sodium sulfonate and pentoxifylline. On the 3rd and 5th hospital day a loss of consciousness occurred in association with vasospasm during hemodialysis. Re-bleeding occurred on the 14th hospital day. Full consciousness was not restored for about 2 weeks. Brain magnetic resonance imaging (MRI) angioraphy was performed on Oct 21 and aneurysmal dilatations were revealed at the left divergent point of the posterior communicating artery from the internal carotid artery and anterior communicating artery. These aneurysms were considered to be the cause of the subarachnoid hemorrhage. Our reported case was considered to be a rare case who was successfully treated without any surgical procedures. It is suggested that HDF by using nafamostat mesilate, strict control of blood pressure with intravenous nicardipine and the concomitant administration of glycerin fructose could be useful in hemodialysis patients developing subarachnoid hemorrhage.