Manickavasagar et al reported criteria for Extrapyramidal Syndromes of Chronic Kidney Disease and Dialysis (EPS-CKDD). It is potentially reversible if an underlying cause is found. The authors are from multiple institutions in Australia.

Patient selection: chronic kidney disease on dialysis


Clinical features:

(1) extrapyramidal movement disorder

(1a) either hypokinetic acute parkinsonism or hyperkinetic acute chorea/athetosis

(2) bilateral basal ganglia injury


Key neuroimaging findings:

(1) bilateral involvement of the putamen and globus pallidus with low attenuation on T2-weighted MRI

(2) variable amount of involvement of the internal capsule white matter


Risk factors:

(1) inadequate dialysis

(2) diabetes

(3) metformin use (with lactic acidosis)

(4) female sex

(5) thiamine deficiency



(1) heavy metal poisoning

(2) abnormality of copper metabolism

(3) hypothyroidism

(4) hyper or hyponatremia

(5) hyper or hypoglycemia

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