Headache during haemodialysis in a patient with shunt: a cause for concern?

• Published in: BMJ case reports Vol. 2015; p. bcr2014208887
• Main Authors: O'Sullivan, Padraig, Sajjad, Jahangir, Abrar, Sahibzada, Marks, Charles
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 27.03.2015; BMJ Publishing Group
• Series: Case Report
• Subjects: Blood pressure; Cysts; Diuretics, Osmotic - therapeutic use; Edema; Europe (West); Female; Headache - drug therapy; Headache - etiology; Headaches; Heart rate; Humans; Mannitol - therapeutic use; Medical imaging; Nausea; Nausea - etiology; Patients; Peritoneal dialysis; Rare Disease; Renal Dialysis - adverse effects; Renal Dialysis - methods; Spina bifida; Surveillance; Ventriculoperitoneal Shunt; Vision Disorders - etiology; Vomiting - etiology; White; Young Adult
• DOI: 10.1136/bcr-2014-208887
• ISSN: 1757-790X

A 20-year-old woman with a functioning ventriculoperitoneal (VP) shunt consistently reported unbearable vertex headaches and nausea during the last hour of her haemodialysis (HD) sessions. After one particularly severe episode, which was associated with vomiting, restlessness and blurred vision, her team suspected that she was developing dialysis disequilibrium syndrome. She improved fully on cessation of HD, requiring simple analgaesia only, and continued dialysis three times per week. Several more distressing episodes of nausea and headaches compelled us to give intravenous mannitol during HD, resulting in temporary improvement. Subsequently, shorter and more frequent dialysis sessions along with intravenous mannitol resulted in satisfactory clinical response.