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Case report
Severe venous congestive encephalopathy secondary to a dialysis arteriovenous graft
  1. Edgar A Samaniego1,
  2. Kevin J Abrams2,
  3. Guilherme Dabus1,
  4. Rosanne Starr1,
  5. Italo Linfante1
  1. 1Department of Neurointerventional Surgery, Baptist Cardiac and Vascular Institute, Miami, Florida, USA
  2. 2Department of Neuroradiology, Baptist Hospital, Miami, Florida, USA
  1. Correspondence to Dr E A Samaniego, Department of Neurointerventional Surgery, Baptist Cardiac and Vascular Institute, 7355 SW 89th St, APT 627 N, Miami, FL 33156, USA; edgarsama{at}gmail.com

The clinical presentation and imaging of venous congestive encephalopathy (VCE) can mimic several neurological conditions, making the diagnosis challenging. We report a patient with end stage renal disease on dialysis who presented with a right occipital infarction. The patient developed progressive encephalopathy and increased intracranial pressure. Extensive imaging, electroencephalography and serum analysis did not explain the cause of his infarction and progressive neurological deterioration. Finally, cerebral angiography and venography demonstrated severe generalized VCE due to arterial shunting from a right upper extremity arteriovenous graft (AVG) and an occluded right innominate venous trunk. The right arm shunt resulted in severe cerebral venous hypertension due to ipsilateral occlusion of the innominate venous trunk. After the AVG was repaired, the cerebral venous hypertension resolved and the patient returned to baseline.

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