Panhemispheric Infarction: A Complication of Cuffed Catheter

Mahendra Agraharkar, MD, FACP, Sumita Gokhale, MD, Robert Cinclair, BS, Jignesh Patel, MD, Rajiv Gupta, MD

Disclosures

South Med J. 2003;96(2) 

In This Article

Abstract and Introduction

The need for reliable vascular access remains the Achilles heel of hemodialysis. Complications of vascular access are a leading cause of morbidity and mortality in patients who undergo hemodialysis, especially in those patients with end-stage renal disease. Among methods of vascular access, arteriovenous fistulae have the lowest rate of infection and should be the access of choice when vascular anatomy permits. Also, the incidence of staphylococcal infections in patients infected with human immunodeficiency virus is increasing. To emphasize the need to use arteriovenous fistula access for hemodialysis whenever possible, we report the case of a patient with end-stage renal disease and human immunodeficiency virus infection who died as a result of panhemispheric infarction and uncal herniation as a result of fulminant staphylococcal bacteremia caused by central venous catheter sepsis.

Staphylococcal infections are occurring with increasing frequency in the setting of human immunodeficiency virus (HIV) infection, and they comprise one-third of all cases of bacteremia, with the risk increasing with decrements in cluster designation 4 (CD4) count. Patients with end-stage renal disease (ESRD) who undergo hemodialysis also have a high incidence of catheter-related complications, such as septicemia, phlebitis, thrombosis, and air embolism. We report the case of a patient with ESRD due to HIV nephropathy who developed fatal panhemispheric infarction and uncal herniation as a result of fulminant staphylococcal bacteremia.

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