Departments of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Departments of Neuroradiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Neurocrit Care. 2017 Oct;27(2):261-264. doi: 10.1007/s12028-017-0394-7.
Contrast-induced encephalopathy (CIE) is a syndrome that may be clinically unrecognized and misdiagnosed as cerebral edema.
Case report and review.
A 72-year-old woman was admitted for elective endovascular embolization of a 10-mm left anterior communicating artery aneurysm. One hour post-procedure, she acutely developed global aphasia. Emergent head computed tomography (CT) and computed tomography-angiography (CTA) showed high attenuation of the left hemispheric subarachnoid spaces interpreted as hemispheric edema; emergent magnetic resonance imaging revealed left hemispheric punctate infarcts. At 12 h, she developed right hemiparesis and encephalopathy. Repeat CTA and CT perfusion revealed decreased left hemisphere cerebral blood flow and diminutive caliber of distal left middle cerebral artery territory vasculature. Repeated angiography with intra-arterial verapamil and systemic blood pressure augmentation were performed for presumed vasospasm. At 20 h, head CT was concerning for worsening left hemispheric edema, but dual-energy, iodine-subtracting sequences revealed significant contrast extravasation contributing to the appearance of sulcal effacement but without actual edema. Out of concern for blood-brain barrier breakdown from CIE, pressor augmentation was discontinued and the patient gradually improved to full neurological recovery within 72 h of symptom onset.
Our case is the first known to report the use of dual-energy, iodine-subtracting CT as a diagnostic tool in differentiating between cerebral edema and pseudoedema in CIE.
对比剂诱导性脑病（CIE）是一种可能临床上未被识别并误诊为脑水肿的综合征。
病例报告和文献复习。
一名 72 岁女性因择期行 10mm 左侧前交通动脉瘤的血管内栓塞术而入院。术后 1 小时，她突发全语言障碍。紧急头部 CT（CT）和 CT 血管造影（CTA）显示左侧半球蛛网膜下腔高度衰减，被解释为半球性水肿；紧急磁共振成像显示左侧半球点状梗死。12 小时后，她出现右侧偏瘫和脑病。重复 CTA 和 CT 灌注显示左侧半球脑血流减少，左侧大脑中动脉区域血管口径缩小。为疑似血管痉挛，再次进行了动脉内维拉帕米和全身血压升高的血管造影。20 小时时，头部 CT 显示左侧半球水肿加重，但双能量、碘减序列显示明显的对比剂外渗导致脑沟消失，但实际上没有水肿。由于担心 CIE 导致血脑屏障破裂，停止了升压治疗，患者在症状出现后 72 小时内逐渐完全恢复神经功能。
我们的病例是首例报道使用双能量、碘减 CT 作为区分 CIE 中脑水肿和假性水肿的诊断工具。
