PDF(Pubmed)
Abstract：
BACKGROUND: Contrast-induced encephalopathy (CIE) is a rare complication during or after angiography, usually transient and reversible. CIE diagnosis is challenging due to the absence of no formal diagnostic criteria. CIE can mimic stroke symptoms, including visual disturbances, seizures, confusion, coma, and focal neurological deficits. This case reports neurological deficit reversal in a CIE patient due to the embolization of an intracranial aneurysm, the second angiographic procedure in six days.
METHODS: A 77-year-old woman was admitted to the hospital for headaches. The cerebral computed tomography (CT) scan indicated a subarachnoid hemorrhage. The first digital subtraction angiography (DSA) identified an aneurysm of 4 mm ∗ 3 mm in size in the M1 segment of the right middle cerebral artery (MCA). Then, embolization surgery was performed for the cerebral aneurysm, which was successful. However, the patient had post-operative headaches, slurred speech, epilepsy, limb weakness, and delirium post-procedure. The non-contrast cerebral CT indicated widespread edema in the right cerebral hemisphere. The patient was diagnosed with CIE and treated with symptomatic supportive therapy. Eventually, the patient\'s neurological deficits and cerebral edema improved significantly.
CONCLUSIONS: The current case emphasized the importance of early diagnosis and symptomatic treatment of CIE. Thus, CIE should be the first consideration during the differential diagnosis of a patient having acute neurological impairment after repeated DSA.
METHODS: A 77-year-old woman was admitted to the hospital for headaches. The cerebral computed tomography (CT) scan indicated a subarachnoid hemorrhage. The first digital subtraction angiography (DSA) identified an aneurysm of 4 mm ∗ 3 mm in size in the M1 segment of the right middle cerebral artery (MCA). Then, embolization surgery was performed for the cerebral aneurysm, which was successful. However, the patient had post-operative headaches, slurred speech, epilepsy, limb weakness, and delirium post-procedure. The non-contrast cerebral CT indicated widespread edema in the right cerebral hemisphere. The patient was diagnosed with CIE and treated with symptomatic supportive therapy. Eventually, the patient\'s neurological deficits and cerebral edema improved significantly.
CONCLUSIONS: The current case emphasized the importance of early diagnosis and symptomatic treatment of CIE. Thus, CIE should be the first consideration during the differential diagnosis of a patient having acute neurological impairment after repeated DSA.
摘要：
背景：造影剂脑病（CIE）是血管造影期间或之后的罕见并发症，通常是瞬态和可逆的。由于缺乏正式的诊断标准，CIE诊断具有挑战性。CIE可以模仿中风症状，包括视觉障碍，癫痫发作,混乱,昏迷,和局灶性神经功能缺损.该病例报告aCIE患者由于颅内动脉瘤的栓塞而导致神经功能缺损逆转，六天后的第二次血管造影手术。
方法：一名77岁女性因头痛入院。脑计算机断层扫描（CT）扫描显示蛛网膜下腔出血。首次数字减影血管造影（DSA）在右大脑中动脉（MCA）的M1段中发现了4mm*3mm大小的动脉瘤。然后，对脑动脉瘤进行了栓塞手术，这是成功的。然而,病人术后头痛,含糊不清的讲话，癫痫,四肢无力,术后谵妄。无造影脑CT提示右脑半球广泛水肿。患者被诊断为CIE，并接受对症支持治疗。最终,患者的神经功能缺损和脑水肿明显改善。
结论：当前病例强调了早期诊断和对症治疗的重要性。因此，在反复DSA后的急性神经功能缺损患者的鉴别诊断中，应首先考虑CIE。
方法：一名77岁女性因头痛入院。脑计算机断层扫描（CT）扫描显示蛛网膜下腔出血。首次数字减影血管造影（DSA）在右大脑中动脉（MCA）的M1段中发现了4mm*3mm大小的动脉瘤。然后，对脑动脉瘤进行了栓塞手术，这是成功的。然而,病人术后头痛,含糊不清的讲话，癫痫,四肢无力,术后谵妄。无造影脑CT提示右脑半球广泛水肿。患者被诊断为CIE，并接受对症支持治疗。最终,患者的神经功能缺损和脑水肿明显改善。
结论：当前病例强调了早期诊断和对症治疗的重要性。因此，在反复DSA后的急性神经功能缺损患者的鉴别诊断中，应首先考虑CIE。
