Prolonged headache and unilateral neurological signs in hemodialysis patients should raise suspicion for subdural hematoma, which can be definitively diagnosed with carotid angiography.
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Subdural hematoma may complicate anticoagulated dialysis; case reports leave open causality and require prospective confirmation.
Two examples of subdural hematoma complicating chronic intermittent dialysis are presented. The administration of anticoagulants seemed to play a significant role, but other factors such as biochemical changes caused by hemodialysis and renal disease may have contributed. Prolonged headache and the appearance of unilateral neurological signs were significant early warnings and helped to differ the presence of a hematoma from the more common neurological changes that sometimes accompany hemodialysis. Carotid angiography definitively established the diagnosis.
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Bechar et al. (1972) studied this question.
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