Criteria – all of the following:
(1) history of exposure to aluminum (see below)
(2) other causes of neurologic syndrome excluded
(3) presence of >= 2 major criteria
(4) presence of 1 major and >= 3 minor criteria
NOTE: Dialysis encephalopathy used to occur in patients exposed to aluminum containing compounds given to control phosphate levels. Aluminum encephalopathy may occur in other persons exposed to aluminum, so I have expanded on the history of exposure.
History of exposure:
(1) long-term hemodialysis (>= 18 months on maintenance therapy or >= 150 hemodialysis sessions) with no control of aluminum-containing agents
(2) long term use of sucralfate in a person with renal failure
(3) occupational
Major criteria:
(1) speech difficulty
(2) seizures
(3) myoclonus
(4) motor dyspraxia
(5) more than 5 pathologic fractures and/or positive aluminum staining in bone biopsy
Minor criteria:
(1) change in mood
(2) change in behavior
(3) intellectual deterioration
(4) episodic confusion related to dialysis or other aluminum exposure
(5) asterixis
(6) serum aluminum level > 50 µg/L
(7) diffuse EEG abnormality
(8) blood transfusions on >= 10 occasions over the past year
