Piršić Ana, Šipić Tomislav, Štambuk Krešimir, Budinčević Hrvoje
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Rom J Intern Med. 2017 Sep 26;55(3):175-177. doi: 10.1515/rjim-2017-0013.
Use of non-ionic contrast media (CM) in coronary arteriography has been reported to cause transient cortical blindness, confusion, amnesia and very rare focal deficits. We report a 69-year old patient with stable angina pectoris who underwent coronary angioplasty with stent placement due to in-stent thrombosis of the right coronary artery and developed stroke symptoms with radiological suspicion of subarachnoid hemorrhage. No vascular malformations were detected on CT cerebral angiography. Dual antiplatelet treatment was continued. Complete neurological recovery was observed within 48 hours post angiography. As observed with repeated CT scans, sulcal hyperdensities mostly faded after 24 hours and totally disappeared within 7 days when she was discharged home. Our case shows transient neurological symptoms and rapid disappearing of sulcal hyperdensities, suggesting temporary blood brain barrier disruption, consequential cerebral infarction and contrast media extravasation as the main mechanisms which allowed us to treat the patient with dual antiplatelet treatment.
据报道，在冠状动脉造影中使用非离子型造影剂（CM）可导致短暂性皮质盲、意识模糊、失忆以及极为罕见的局灶性神经功能缺损。我们报告了一名69岁稳定型心绞痛患者，该患者因右冠状动脉支架内血栓形成接受了冠状动脉血管成形术并置入支架，术后出现中风症状，影像学怀疑为蛛网膜下腔出血。脑部CT血管造影未发现血管畸形。继续进行双联抗血小板治疗。血管造影术后48小时内观察到神经功能完全恢复。如多次CT扫描所示，脑沟高密度影大多在24小时后消退，出院时7天内完全消失。我们的病例显示出短暂性神经症状以及脑沟高密度影迅速消失，提示血脑屏障暂时破坏、继发性脑梗死和造影剂外渗是主要机制，这使我们能够对该患者进行双联抗血小板治疗。
