Background: 

Central venous obstruction (stenosis or occlusion) is common in patients with renal failure on hemodialysis and may be associated with intracranial hypertension (IH). Causes include vein injury from an endoluminal device, lumen obstruction from a device or thrombus, external vein compression, and high venous flow leading to vein intimal hyperplasia. A combination of high venous flow and central venous obstruction can lead to intracranial venous hypertension, impaired cerebrospinal fluid (CSF) resorption, and subsequent IH.

Evidence Acquisition: 

We conducted a search of the English literature using the Ovid MEDLINE Database and PubMed, with a focus on reports involving IH and central venous obstruction in the setting of hemodialysis. We reviewed CSF flow dynamics, the risk factors and causes of central venous obstruction, and the evaluation, management, and outcomes of central venous obstruction-induced IH.

Results: 

Twenty-four cases of IH related to central venous obstruction in hemodialysis patients were identified. Twenty patients had headaches (83.3%) and 9 had visual symptoms (37.5%). The brachiocephalic vein was the most common site of stenosis or occlusion (20/24, 83.3%). Twenty-one patients (87.5%) had resolution of IH with treatment. Two patients died from complications of IH (8.3%).

Conclusions: 

Central venous obstruction–induced IH is likely underrecognized by clinicians and mimics idiopathic IH. Hemodialysis patients with IH should be screened with computed tomography venography of the chest. Optimal treatment is with vascular intervention or a CSF diversion procedure and can help prevent vision loss from papilledema or nervous system damage. Medical management may be appropriate in mild cases or as a bridge to definitive interventional treatment. Increased awareness among clinicians has potential to facilitate the timely diagnosis of this treatable condition with potential for good neurologic and visual outcomes.

中文翻译：

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血液透析患者的中心静脉阻塞引起的颅内高压：颅内压升高的原因尚未被认识。

背景： 

血液透析肾衰竭患者常见中央静脉阻塞（狭窄或闭塞），并可能与颅内高压（IH）相关。原因包括腔内装置引起的静脉损伤，装置或血栓引起的管腔阻塞，外部静脉压迫以及导致静脉内膜增生的高静脉流量。高静脉血流和中心静脉阻塞的结合可导致颅内静脉高​​压，脑脊液（CSF）吸收受损和随后的IH。

取证： 

我们使用Ovid MEDLINE数据库和PubMed对英语文献进行了搜索，重点是涉及血液透析环境中IH和中心静脉阻塞的报道。我们审查了脑脊液流动动力学，中心静脉阻塞的危险因素和原因，以及中心静脉阻塞引起的IH的评估，管理和结果。

结果： 

在血液透析患者中​​鉴定出24例与中心静脉阻塞相关的IH。20例头痛（83.3％），9例视觉症状（37.5％）。头臂静脉是狭窄或闭塞的最常见部位（20 / 24，83.3％）。21例患者（87.5％）经治疗可解决IH。2例患者死于IH并发症（8.3％）。

结论： 

中枢静脉阻塞引起的IH可能被临床医生所忽视，并模仿特发性IH。IH的血液透析患者应使用胸部X线计算机断层扫描术进行筛查。最佳治疗是通过血管干预或CSF转移程序进行的，可以帮助防止视乳头水肿或神经系统损害引起的视力下降。在轻度病例中可能适合进行医疗管理，或作为最终干预治疗的桥梁。临床医生意识的增强有可能促进对这种可治疗疾病的及时诊断，并具有良好的神经和视觉效果。