Gollol Raju Narasimha Swamy, Joshi Deepak, Daggubati Ramesh, Movahed Assad
Narasimha Swamy Gollol Raju, Department of Internal Medicine, East Carolina University-Brody School of Medicine, Greenville, NC 27834, United States.
World J Clin Cases. 2015 Nov 16;3(11):942-5. doi: 10.12998/wjcc.v3.i11.942.
Neurotoxicity is an infrequent adverse reaction to iodinated contrast agents. Contrast induced neurotoxicity following coronary angiogram is very rare. Renal disease is a risk factor for contrast induced neurotoxicity. We report a case of contrast induced neurotoxicity following coronary angiogram and intervention using Iohexol (Omnipaque 350) in an end stage renal disease patient on peritoneal dialysis who had prior exposure to iodinated contrast without any adverse reaction. Hemodialysis had to be initiated for rapid removal of the contrast agent with subsequent complete resolution of neurological deficits. This case highlights the need for interventionalists to be aware of an important adverse reaction to iodinated contrast agents, especially in individuals with renal dysfunction, and that neurotoxicity is a possibility even with prior uneventful exposures. The role and timing of hemodialysis in contrast induced neurotoxicity in patients with chronic kidney disease and in those without chronic kidney disease needs further deliberation.
神经毒性是碘化造影剂罕见的不良反应。冠状动脉造影后造影剂诱发的神经毒性非常罕见。肾病是造影剂诱发神经毒性的一个危险因素。我们报告了一例终末期肾病患者在接受腹膜透析且既往接触过碘化造影剂无任何不良反应的情况下，冠状动脉造影及介入治疗后使用碘海醇（欧乃派克350）诱发神经毒性的病例。必须启动血液透析以快速清除造影剂，随后神经功能缺损完全恢复。该病例凸显了介入医生需要了解碘化造影剂这一重要不良反应，尤其是在肾功能不全患者中，并且即使既往接触造影剂无不良事件发生，仍有可能发生神经毒性。血液透析在慢性肾病患者和非慢性肾病患者造影剂诱发神经毒性中的作用和时机需要进一步探讨。
