Khan Shahid M, Ho David W, Lazar Jason M, Marmur J D
Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA.
SAGE Open Med Case Rep. 2014 Apr 7;2:2050313X14530283. doi: 10.1177/2050313X14530283. eCollection 2014.
We report a diagnostic dilemma in a rare case of cerebral contrast retention after difficult cardiac catheterization in an elderly patient loaded with prasugrel.
Our case report describes a 77-year-old female with history of hypertension, diabetes, and dyslipidemia who presented to emergency department complaining of chest pain. Patient was found to have an inferior wall ST elevation myocardial infarction. The patient was loaded with aspirin and prasugrel and taken for emergent cardiac catheterization. Cardiac catheterization revealed two-vessel coronary artery disease with unsuccessful attempt of percutaneous intervention. Immediately after procedure, patient developed an episode of seizure. Emergent computed tomography scan of the brain revealed hyperdensity in the right frontoparietal region consistent with intracerebral bleed. Repeat computed tomography (24 h later) revealed substantial interval improvement of hyperdensity. Follow-up magnetic resonance imaging of the head was normal. Given the lack of magnetic resonance imaging changes, the rate of resolution on computed tomography without expected subacute changes, and the lack of neurologic findings, the initial hyperdensity seen on computed tomography of the brain was believed to be secondary to contrast leakage during cardiac catheterization as opposed to intracranial hemorrhage.
我们报告了一例老年患者在服用普拉格雷后进行困难心脏导管插入术后出现脑部造影剂滞留的罕见诊断难题。
我们的病例报告描述了一名77岁女性，有高血压、糖尿病和血脂异常病史，因胸痛就诊于急诊科。患者被诊断为下壁ST段抬高型心肌梗死。患者服用了阿司匹林和普拉格雷并接受了紧急心脏导管插入术。心脏导管插入术显示双支冠状动脉疾病，经皮介入尝试未成功。术后立即，患者发生了一次癫痫发作。脑部紧急计算机断层扫描显示右额顶叶区域高密度，符合脑出血。重复计算机断层扫描（24小时后）显示高密度有显著的间隔期改善。头部的后续磁共振成像正常。鉴于缺乏磁共振成像变化、计算机断层扫描上的分辨率且无预期的亚急性变化以及缺乏神经系统体征，脑部计算机断层扫描上最初看到的高密度被认为是心脏导管插入术期间造影剂渗漏所致，而非颅内出血。
