对比剂脑病(CIE)是心导管插入术的罕见并发症;临床表现包括皮质盲,癫痫发作和局灶性神经功能缺损.总的来说,与其他并发症相比,碘克沙醇心导管插入术后复发性癫痫发作的发生率更高。
这里,我们报道了一例76岁男性患者,他经历了近10个月的不稳定型心绞痛并被我们医院收治.使用碘克沙醇进行重复心导管插入术。第一次心导管插入后约20小时,他的上肢开始出现轻微的颤抖;病人意识清醒,无法控制这些动作。在进行第二次心导管插入术之前总共发生了6次发作,每次发作持续约2s。这些症状没有得到治疗。第二次心导管插入后约2小时,症状变得更加严重,发作频率明显增加;第二次手术后6小时症状完全消退。脑电图(EEG)显示弥漫性减慢并伴有癫痫样异常。在双侧区域观察到阵发性尖峰波和慢波放电,异常标记在额叶区域。这些观察使我们得出结论,患者正在经历癫痫发作。在出院后6个月的每月临床随访期间,心脏病学家或神经学家没有发现神经系统异常,病人的脑电图正常.在整个过程中没有施用抗癫痫药物。
CIE,尤其是反复发作的癫痫,是碘克沙醇心导管插入术的一种罕见但通常可逆的并发症。它的症状可能是轻微的,因此很容易被医生忽视。早期CIE检测可以通过EEG实现。反复暴露于造影剂会带来复发性癫痫发作的风险。
Contrast-induced encephalopathy (CIE) is a rare complication of cardiac catheterization; clinical manifestations include cortical blindness, seizures and focal neurological deficits. In general, recurrent epileptic seizures following cardiac catheterization with iodixanol occur more rarely than do other complications.
Here, we report a
case of a 76-year-old male patient who experienced unstable angina for nearly 10 months and was admitted to our hospital. Repeat cardiac catheterization was performed using iodixanol. At approximately 20 h after the first cardiac catheterization, his upper limbs began to exhibit slight trembling; the patient was conscious and could not control these movements. A total of 6 episodes occurred before the second cardiac catheterization was performed, with each episode lasting approximately 2 s. These symptoms were not treated. At approximately 2 h after the second cardiac catheterization, the symptoms became more severe, and the frequency of the episodes increased significantly; the symptoms had fully subsided at 6 h after the second operation. An electroencephalogram (EEG) demonstrated diffuse slowing with epileptiform abnormalities. Paroxysmal spike-wave and slow wave discharges were observed in the bilateral areas, and the abnormalities were marked in the frontal areas. These observations led us to conclude that the patient was experiencing epileptic seizures. During 6 months of monthly clinical follow-up visits after discharge, no abnormalities of the nervous system were found by cardiologists or neurologists, and the patient\'s EEG was normal. No antiepileptic drugs were administered throughout this process.
CIE, especially recurrent epileptic seizures, is a rare but often reversible complication of cardiac catheterization with iodixanol. Its symptoms can be mild and therefore are easily ignored by physicians. Early CIE detection may be achieved by EEG. Repeated exposure to contrast agents carries the risk of recurrent epileptic seizures.