Uremic Encephalopathy

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Various neurologic complications develop in patients with renal failure and in patients receiving hemodialysis and peritoneal dialysis. Uremic encephalopathy presents with tremor, asterixis, myoclonic jerks, seizures, and stupor, which may progress to coma.

figure 10.7

Hypoglycemic encephalopathy. A 68-year-old diabetic man, following administration of 11 units regular insulin, suffered a hypoglycemic episode with a blood glucose concentration of 28 mg/100 mL for approximately 8 hours. During this episode, he became comatose and, without regaining consciousness, died 15 days later. Eosinophilic neurons and mild astrocytosis (HE) are present in the thalamus.

Neuropathologic findings include cerebral cytotoxic edema; neuronal losses in the cerebral and cerebellar cortex, deep gray structures and brainstem; perivascular demyelination; and occasional subdural hematoma.

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