Intractable dialysis-associated headache: a management dilemma in pediatric hemodialysis.
Aviad Schnapp, Amir Shimonov, Ari Simckes et al.
✦ AI-curated · Sources linked
Case in brief
An adolescent with stage 5 chronic kidney disease and a ventriculoperitoneal shunt developed severe headache during hemodialysis. Evaluation did not identify dialysis disequilibrium, biochemical or hemodynamic causes, a primary headache disorder, infection, vascular or ophthalmologic pathology, or shunt malfunction. As focal neurological findings progressed, further investigation revealed a diffuse intramedullary spinal cord glioma.
What made this case unusual
The severe intradialytic headache initially had no identified dialysis-related or other common cause; progressive focal neurological findings led to discovery of a spinal cord glioma.
Diagnostic / clinical pearl
Refractory headache during dialysis should not be attributed solely to dialysis-related causes; evolving focal neurological findings warrant repeated assessment.
Why it matters
The case illustrates the value of multidisciplinary evaluation when severe symptoms remain unexplained in a pediatric dialysis patient.