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August 18, 1978

Unilateral Asterixis in a Dialysis Patient

Author Affiliations

From the Department of Internal Medicine, Naval Regional Medical Center, San Diego.

JAMA. 1978;240(7):671. doi:10.1001/jama.1978.03290070073024

ASTERIXIS is seen with many metabolic disorders, the most common being liver failure, renal failure, hyponatremia, and hypercapnea.1 In the vast majority of cases, it is bilateral, although unilateral flapping has been occasionally described.1-4 In these cases the unilateral asterixis appeared to be due to anoxia of the contralateral cerebral hemisphere. We report a case of unilateral rightsided asterixis in a uremic patient who subsequently was found to have severe left carotid artery stenosis.

Report of a Case  A 55-year-old man with a six-month history of fatigue and anorexia and an 18-kg weight loss was admitted to the hospital for hemodialysis. For seven years he had been undergoing treatment for hypertension with hydralazine hydrochloride, furosemide, and methyldopa with only moderate success. He had been admitted to another hospital with renal failure and an initial creatinine level of 18.6 mg/dl. Examination at the time showed a blood pressure of