| 左凤萍,刘美君,邓鑫敏,等.急性缺血性卒中脑血管造影术后并发对比剂脑病 1例[J].安徽医药,2026,30(3):529-532. |
| 急性缺血性卒中脑血管造影术后并发对比剂脑病 1例 |
| Acute ischemic stroke complicated by contrast-induced encephalopathy after cerebral angiography: a case report |
| |
| DOI：10.3969/j.issn.1009-6469.2026.03.019 |
| 中文关键词: 脑血管造影术 药物相关性副作用和不良反应 对比剂 脑病 急性缺血性卒中 碘克沙醇 高血压 |
| 英文关键词: Cerebral angiography Drug-related side effects and adverse reactions Contrast medium Encephalopathy Acute ischemic stroke Iodixanol Hypertension |
| 基金项目:四川省科技计划重点研发项目( 2021YFS0260)；成都中医药大学附属医院科技发展基金课题( 21ZL12) |
| 作者 | 单位 | E-mail | | 左凤萍 | 成都中医药大学临床医学院,四川成,都 610075 | | | 刘美君 | 成都中医药大学附属医院神经内科,四川成都 610072 | | | 邓鑫敏 | 成都中医药大学临床医学院,四川成,都 610075 | | | 常文 | 成都中医药大学临床医学院,四川成,都 610075 | | | 张井莹 | 成都中医药大学临床医学院,四川成,都 610075 | | | 杨叶 | 成都中医药大学临床医学院,四川成,都 610075 | | | 梁静涛 | 成都中医药大学附属医院神经内科,四川成都 610072 | oliveliang@aliyun.com |
|
| 摘要点击次数: 296 |
| 全文下载次数: 1812 |
| 中文摘要: |
| 目的探索急性缺血性卒中脑血管造影术后并发对比剂脑病( CIE)治疗经验。方法选取成都中医药大学附属医院 2023年 11月收治的 1例急性缺血性卒中病人，其在使用碘克沙醇行脑血管造影术后出现较严重的可逆性中枢神经系统缺损，结合最新研究进展系统回顾总结 CIE的临床表现、危险因素、诊治策略及预后。结果病人主诉语言謇涩 9h余。术前诊断:急性脑梗死，高血压 2级， 2型糖尿病。入院第 5天行脑血管造影术，术后病人出现突发意识改变及局灶性神经功能缺损、偏瘫侧肢体肌力进行性下降等体征，诊断 CIE。后因呕吐导致误吸继发吸入性肺炎。颅脑 CT示左侧额顶叶密度较右侧略增高。头颅磁共振成像( MRI)示左侧额叶、左侧半卵圆中心及左侧顶叶局部 T2加权液体衰减反转恢复( T2 FLAIR)序列高信号增多。胸部 CT示双肺下叶感染。经水化促对比剂排出，静脉滴注甘露醇脱水减轻脑水肿、尼莫地平注射液缓解血管痉挛、美罗培南抗感染、地塞米松减轻神经血管水肿，以及控制血压等治疗，病人恢复至造影前状态。结论造影术后出现病情恶化、影像学提示脑水肿改变，特别是既往高血压或卒中病史的病人，应考虑 CIE。早期诊断、支持性治疗以及控制危险因素是影响病人预后的关键。 |
| 英文摘要: |
| Objective To explore the treatment experience of acute ischemic stroke complicated by contrast-induced encephalopathy (CIE) after cerebral angiography.Methods A patient with acute ischemic stroke admitted to Hospital of Chengdu University of TCMin November 2023 was selected, who developed severe but reversible central nervous system defect after cerebral angiography using io.dixanol. The clinical manifestations, risk factors, diagnosis and treatment strategy and prognosis of CIE were systematically reviewedbased on the latest research progress.Results The patient complained of speech retardation for more than 9 hours. The preoperativediagnosis was acute cerebral infarction, hypertension grade 2, and Type 2 diabetes. Cerebral angiography was performed on the 5th dayafter admission. The patient showed signs of sudden change of consciousness, focal neurological deficits and progressive decline of mus.cle strength of hemiplegic side after operation, leading to a diagnosis of CIE. Later, aspiration pneumonia was caused by aspiration dueto vomiting. Head CT results showed that the density of frontal parietal lobe was slightly higher on the left side than on the right side.Head MRI results showed an increase in localized T2 weighted fluid attenuated inversion recovery (T2 FLAIR) sequence in the left fron.tal lobe, left center hemioval, and left parietal lobe. A chest CT scan showed infection of the lower lobes of both lungs. After the elimina.tion of hydrating contrast promoter, mannitol injection for dehydration to reduce cerebral edema, nimodipine injection for vasospasm,meropenem for anti-infection, dexamethasone for neurovascular edema, and blood pressure control, the patient returned to the pre-angi. ography state.Conclusions CIE should be considered in patients with deterioration after cerebral angiography and changes in brainedema indicated by imaging, especially in patients with a previous history of hypertension or stroke. Early diagnosis, supportive treat.ment and control of risk factors are the keys to the prognosis of patients. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
