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
Exclusions:
(1) heavy metal poisoning
(2) abnormality of copper metabolism
(3) hypothyroidism
(4) hyper or hyponatremia
(5) hyper or hypoglycemia
