Recently, the age of patients receiving chronic hemodialysis has markedly increased and diabetic nephropat in aged subjects is often induced by dialysis. Consequently, many aspects of the patterns and features of cerebrovascular diseases complicated by dialysis are changin. 1. Cerebral hemorrhage in chronic dialysis patients are more frequent and more severer than in non-dialys subjects or the general population. Subcortical hemorrhage, is more frequently seen in dialytics, the cause of whic is

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... unknown. However, in aged persons, amyloid degeneration of the cerebral arteries is common, so cerebra hemorrhage due to amyloid angiopathy must be cautiously checked, although we have no clinical method of detecting amyloid angiopathy in daily practice. The incidence of cerebral hemorrhage in dialytics has decreased in recent years, perhaps due to effective contro of hypertension and improvement of dialysis techniques, but the frequency of cerebral infarction may increas again. Pathogenesis of cerebral hemorrhage in dialytics is discusse. 2. In a cranial MRI study on 71 dialysis patients without cerebrovascular signs and symptoms, ischem changes were classified into cerebral white matter lesions, lacunes and brain stem infarctio. a) Ischemic brain changes on MRI were found in 38 subjects (53.5%), but cerebral hemorrhage was found in only 1 patient (1.4%). In the remaining 32 (45.1%), there were no abnormal images. Ischemic lesions on MR were found more than half of the dialysis subjects and increased with advancing age; above 70 years of age, practically all patients showed ischemic changes on MRI imaging. The frequency of brainstem lesions showed no age-difference. lacunes were reduced after middle-age, while cerebral white matter lesions increased linearly wi advancing age. Although asymptomatic cerebral lesions were found in many of dialysis patients, whether they were really "asymptomatic" or not, is an important issue. Psychiatric evaluations are needed in dialysis patien, because depression or other psychiatric manifestations are not rare in these subject. 3. Six dialysis patients with cerebral hemorrhage or cerebral infarction verified on MRI and/or at autopsy are presented. A 47-year-old male patient with autosomal dominant polycystic kidney disease (PKD) showed a massive cerebral hemorrhage in the putaminal region. Intracranial aneurysms were not found in this patie. Genetic relationship in autosomal dominant PKD is discussed, especially in relation to collagen gene.