背景:对比剂诱导性脑病(CIE)被认为是心导管插入术后的一种罕见并发症。由于各种表现形式,CIE没有正式的诊断标准。事实上,CIE的发病率可能被大大低估,因为它与其他脑血管并发症的鉴别诊断存在困难。因此,根据患者的临床症状和心导管插入后的检查做出流程图,以帮助临床医生诊断E是重要和必要的。
方法:在本报告中,我们描述了一例66岁的中国高血压患者的probableCIE病例,该患者在分叉病变中进行了心脏导管插入术,支架放置在分叉病变中,在此期间使用80毫升碘普罗胺对比剂。按照该程序大约2小时,病人突然失去意识,患有癫痫持续状态。通过连续心电图监测未发现恶性心律失常,但在I导联和aVL中显示出轻度ST段抬高。超声心动图,血糖和电解质水平正常。在罪犯病变中进行了急诊再血管造影并经皮冠状动脉腔内成形术,其中涉及60毫升碘普罗胺造影剂。然而,患者仍然昏迷和癫痫持续。头部的非对比计算机断层扫描(CT)显示皮质和蛛网膜下增强,以及对比剂在大脑中动脉中的长时间保留。通过静脉补水的支持治疗,镇静剂和脱水剂,3小时后患者康复,最终出院,无任何神经功能缺损。
结论:CIE是一种由造影剂引起的急性可逆性脑病。由于对CIE的定义缺乏共识,因此在心脏导管插入后对CIE进行诊断非常具有挑战性。通过这一案例,我们回顾了相关文献,通过它给出了鉴别诊断和临床决策的流程图,这可能有助于区分心脏导管插入术后的CIE和其他神经系统并发症。
Contrast-induced encephalopathy (CIE) is considered as an uncommon complication following cardiac catheterization. Due to the varied manifestations, CIE has no formal diagnostic criteria. In fact, the incidence of CIE may be greatly underestimated because of the difficulty in its differential diagnosis with other cerebrovascular complications. Thus, making a flow diagram according to patients\' clinical symptoms and examinations after cardiac catheterization to help clinicians diagnose CIE is important and needed.
In this report, we describe a case of probable CIE in a 66-year-old Chinese man with hypertension who underwent cardiac catheterization with stents placement in the bifurcation lesion, during which 80 ml iopromide contrast was used. About 2 h following the procedure, the patient lost his consciousness suddenly and suffered from a status epilepticus. Malignant arrhythmias were not found through continuous electrocardiogram monitoring, but mild ST-segment elevation was displayed in leads I and aVL. The echocardiography, plasma glucose and electrolyte levels were normal. Emergency re-angiography with percutaneous transluminal coronary angioplasty was performed in the culprit lesion, which involved 60 ml iopromide contrast. However, the patient remained unconsciousness and epilepticus. Non-contrast computed tomography (CT) of the head showed cortical and subarachnoid enhancement as well as prolonged retention of contrast media in the middle cerebral artery. With supportive treatment of intravenous hydration, sedative and dehydrant, the patient recovered 3 h later and finally discharged without any neurological deficits.
CIE is an acute reversible encephalopathy induced by contrast media. It is exceptionally challenging to make the diagnosis of CIE following cardiac catheterization since there is a lack of consensus on the definition of CIE. Via this case we reviewed the related literatures, through which a flow diagram of the differential diagnosis and clinical decision making was given, which could help to differentiate CIE from other neurological complications following cardiac catheterization.