Catheter-associated Central Venous Stenosis Presenting as Persistent Headache in a Dialysis Patient

Abstract

Background: Central venous stenosis (CVS) is a known complication of central venous access and often presents as superior vena cava (SVC) syndrome. However, non-specific symptoms such as persistent headaches are rarely associated with CVS, leading to delayed diagnosis.

Case Summary: We report a 68-year-old woman with end-stage kidney disease on regular haemodialysis (HD) who presented with persistent headaches, fever, and cough. Initial treatment for presumed hypertensive urgency provided no symptom relief. Further examination revealed left upper limb swelling, distended veins, and elevated jugular venous pressure (JVP). Notably, these symptoms worsened post-HD. A central venogram confirmed complete stenosis of the left brachiocephalic vein. After switching HD access, the patient’s headaches resolved.

Conclusion: This case highlights the importance of considering catheter-associated CVS in dialysis patients with unexplained headaches, even when typical SVC syndrome features are absent. Early diagnosis and treatment are critical for preventing further complications, including the loss of dialysis access.