Summary
The association of progressive multifocal leukoencephalopathy (PML) with prolonged hemodialysis treatment (PHT), not previously reported, was observed in a 56-year-old Japanese man who received PHT for 11 years. He suffered from recurrent bouts of fever and progressive neurological signs, such as irritability, speech disturbance, gait disturbance and dysphagia for seven months, and finally fell into a deep coma and died. Clinical signs and symptoms were highly suggestive of progressive dialysis encephalopathy. Necropsy revealed that the PML mainly involved the brainstem and cerebellar white matter. The aluminium content of the brain tissue was lower than that of controls. Possibly the virus causing PML is one of the causes of progressive dialysis encephalopathy, since clinically PML is not easily distinguished from progressive dialysis encephalopathy. It is essential to differentiate PML of viral etiology from progressive dialysis encephalopathy of unknown cause.
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References
Adams JH (1976) Virus diseases of the nervous system. In: Blackwood W, Corsell JAN (eds) Greenfield's neuropathology, 3rd edition, Edward Arnold, Edinburgh, pp 314–317
Alfrey AC, Mishell JM, Burks J, Contiguglia SR, Rudolph H, Lewin E, Holmes JH (1972) Syndrome of dyspraxia and multifocal seizures associated with chronic hemodialysis. Trans Am Soc Artif Int Organs 18:257–261
Alfrey AC, Gary R, LeGendre MS, Kaehny WD (1976) The dialysis encephalopathy syndrome. New Engl J Med 294:184–188
Åströme KE, Mancall EL, Richardson EP (1958) Progressive multifocal leukoencephalopathy. A hitherto unrecognized complication of chronic lymphatic leukemia and Hodgkin's disease. Brain 81:93–111
Barratt LJ, Lawrence JR (1976) Dialysis-associated dementia. Aust NZJ Med 5:62–65
Berkseth R, Mahowald M, Anderson D, Spiro F (1978) Dialysis encephalopathy: Diagnostic criteria and epidermology of 39 patients. Kidney Int 14:670
Bone I (1978) Progressive dialysis encephalopathy. In: Davison AM (ed) Dialysis review. Pitman Medical Publ, London, pp 216–229
Burks JS, Alfrey AC, Huddlestone J, Norenberg MD, Lewin E (1976) A fatal encephalopathy in chronic hemodialysis patients. Lancet i:764–768
Cameron KR, Birchall SM, Mores MA (1978) Isolation of foamy virus from patient with dialysis encephalopathy. Lancet ii:796
Chokroverty S, Bruetman ME, Berger V, Reyes MG (1976) Progressive dialysis encephalopathy. J Neurol Neurosurg Psychiatr 39:411–419
Dobbelstein H (1976) Immune system in uremia. Nephron 17:409–414
Johnson RT, Narayan O, Weiner LP, Greenlee JE (1977) Progressive multifocal leukoencephalopathy. In: Meulem V, Katz M (eds) Slow virus infection of the central nervous system. Springer, New York Heidelberg Berlin, pp 91–100
Kaehny WD, Alfrey AC, Holman RE, Shorr WJ (1977) Aluminium transfer during hemodialysis. Kidney Int 12:361–365
Mahurkar SD, Dhar SK, Salta R, Meyers L Jr, Smith EC, Dunea G (1973) Dialysis dementia. Lancet i:1412–1415
Padgett BL, ZuRhein GM, Walker DL, Eckroad RJ (1971) Cultivation of papova-like virus from human brain with progressive multifocal leukoencephalopathy. Lancet i:1257–1260
Platt MM, Goode GC, Hislop JS (1977) Composition of the domestic water supply and the incidence of fractures and encephalopathy in patients on home dialysis. Br Med J 2:657–660
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Matsubara, O., Nakagawa, S., Shinoda, T. et al. Progressive multifocal leukoencephalopathy associated with prolonged hemodialysis treatment. Vichows Archiv A Pathol Anat 403, 301–305 (1984). https://doi.org/10.1007/BF00694906
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DOI: https://doi.org/10.1007/BF00694906