Matsubara Noriaki, Izumi Takashi, Miyachi Shigeru, Ota Keisuke, Wakabayashi Toshihiko
Department of Neurosurgery, Nagoya University Graduate School of Medicine.
Department of Neurosurgery, Chubu Rosai Hospital.
Neurol Med Chir (Tokyo). 2017 Dec 15;57(12):641-648. doi: 10.2176/nmc.oa.2017-0132. Epub 2017 Oct 31.
Contrast-induced encephalopathy is a very rare complication associated with endovascular treatment of intracranial aneurysms. Patients with renal dysfunction may be prone to developing contrast medium neurotoxicity as a result of delayed elimination of the contrast medium in renal metabolism. This article focuses on our experience with contrast-induced encephalopathy in patients with end-stage renal disease requiring hemodialysis. The authors retrospectively reviewed five patients diagnosed with contrast-induced encephalopathy who underwent aneurysm coil embolization at their institution from January 2006 to December 2015. During the 10-year period, embolization was performed in 755 cases, among which contrast-induced encephalopathy occurred in five patients (0.66%). Three of the five patients were undergoing dialysis for chronic renal failure (one male and two female; mean age 66.7). Embolization for hemodialysis patients was performed in eight during the same period and the incidence of contrast-induced encephalopathy in hemodialysis patients is quite high in our series (3 of 8; 38%). Procedures were performed in one for recurrence of unruptured anterior-communicating artery aneurysm and in two for unruptured basilar-tip aneurysm. Mean approximately 220 ml of contrast media was used among three hemodialysis patients. All three patients showed an improvement or a control in symptoms soon after hemodialysis. Recovery of neurological symptoms was complete in two and almost normal in one within 1 week after intervention. Contrast-induced encephalopathy should be kept in mind as an expected complication of aneurysm embolization in hemodialysis patients. In hemodialysis patients with contrast-induced encephalopathy, performing hemodialysis is an effective treatment to improve symptoms early.
造影剂诱发的脑病是一种与颅内动脉瘤血管内治疗相关的非常罕见的并发症。肾功能不全的患者可能由于造影剂在肾脏代谢中清除延迟而易于发生造影剂神经毒性。本文重点介绍我们在终末期肾病需要血液透析的患者中治疗造影剂诱发的脑病的经验。作者回顾性分析了2006年1月至2015年12月在其机构接受动脉瘤弹簧圈栓塞术且被诊断为造影剂诱发的脑病的5例患者。在这10年期间，共进行了755例栓塞术，其中5例患者（0.66%）发生了造影剂诱发的脑病。5例患者中有3例因慢性肾衰竭正在接受透析治疗（1例男性和2例女性；平均年龄66.7岁）。同期对8例血液透析患者进行了栓塞术，在我们的系列研究中血液透析患者造影剂诱发的脑病发生率相当高（8例中的3例；38%）。其中1例因未破裂的前交通动脉瘤复发进行手术，2例因未破裂的基底动脉尖动脉瘤进行手术。3例血液透析患者平均使用了约220毫升造影剂。所有3例患者在血液透析后不久症状均有改善或得到控制。2例患者的神经症状在干预后1周内完全恢复，1例几乎恢复正常。造影剂诱发的脑病应被视为血液透析患者动脉瘤栓塞术的一种预期并发症。对于发生造影剂诱发的脑病的血液透析患者，进行血液透析是早期改善症状的有效治疗方法。
