Undiagnosed Stroke and Neurological Manifestations in Chronic Kidney Disease: A Case Series

Abstract

Chronic kidney disease (CKD) is associated with increased risk of neurological complications, but data describing these conditions and associated neuroimaging findings remain limited, particularly in resource-limited settings. This study aims to describe neurological manifestations and brain imaging abnormalities in hospitalized patients with CKD. We retrospectively analyzed 39 patients with CKD stages II–V who underwent neurological consultation and non-contrast head MSCT (multislice computed tomography) at a tertiary referral hospital in Sukoharjo, Indonesia, during 2025. Data were collected from medical records including demographics, clinical status, neurological complaints, imaging findings, and ICD-10 diagnoses. This case series was reported in accordance with CARE guidelines. The median age was 58 years (IQR 49–67), and 22 patients (56.4%) were male. Most patients had stage V CKD (84.6%), and 29 (74.4%) were on routine hemodialysis. Hypertension was present in 79.5% and diabetes mellitus in 41.0%. Non-contrast head MSCT revealed cerebrovascular pathology in 79.5% of patients, with cerebral infarction in 71.8%. The most common anatomical locations of infarction were the frontal lobe (35.7%), corona radiata (28.6%), and basal ganglia (25.0%). Cerebrovascular disease is highly prevalent among hospitalized CKD patients with neurological symptoms. Cerebral infarction was identified in approximately 71.8% of patients. The high discrepancy between clinical and radiological diagnoses suggests that stroke may be underrecognized in CKD patients, particularly when symptoms are attributed to metabolic encephalopathy. Early neuroimaging should be considered in CKD patients presenting with acute neurological symptoms.