Department of Cardiology, the Fifth Affiliated Hospital, Nanchang University, College of Medicine, Fuzhou, 344000, Jiangxi, China.
Department of Neurology, the Fifth Affiliated Hospital, Nanchang University, College of Medicine, Fuzhou, 344000, Jiangxi, China.
BMC Cardiovasc Disord. 2020 Feb 13;20(1):79. doi: 10.1186/s12872-020-01341-3.
Contrast-induced encephalopathy (CIE) is a rare complication of cardiac catheterization; clinical manifestations include cortical blindness, seizures and focal neurological deficits. In general, recurrent epileptic seizures following cardiac catheterization with iodixanol occur more rarely than do other complications.
Here, we report a case of a 76-year-old male patient who experienced unstable angina for nearly 10 months and was admitted to our hospital. Repeat cardiac catheterization was performed using iodixanol. At approximately 20 h after the first cardiac catheterization, his upper limbs began to exhibit slight trembling; the patient was conscious and could not control these movements. A total of 6 episodes occurred before the second cardiac catheterization was performed, with each episode lasting approximately 2 s. These symptoms were not treated. At approximately 2 h after the second cardiac catheterization, the symptoms became more severe, and the frequency of the episodes increased significantly; the symptoms had fully subsided at 6 h after the second operation. An electroencephalogram (EEG) demonstrated diffuse slowing with epileptiform abnormalities. Paroxysmal spike-wave and slow wave discharges were observed in the bilateral areas, and the abnormalities were marked in the frontal areas. These observations led us to conclude that the patient was experiencing epileptic seizures. During 6 months of monthly clinical follow-up visits after discharge, no abnormalities of the nervous system were found by cardiologists or neurologists, and the patient's EEG was normal. No antiepileptic drugs were administered throughout this process.
CIE, especially recurrent epileptic seizures, is a rare but often reversible complication of cardiac catheterization with iodixanol. Its symptoms can be mild and therefore are easily ignored by physicians. Early CIE detection may be achieved by EEG. Repeated exposure to contrast agents carries the risk of recurrent epileptic seizures.
对比剂诱导性脑病（CIE）是心脏导管检查的罕见并发症；临床表现包括皮质盲、癫痫发作和局灶性神经功能缺损。一般来说，与其他并发症相比，碘克沙醇心脏导管检查后反复发生癫痫发作的情况更为少见。
本文报告了 1 例 76 岁男性患者，近 10 个月来反复出现不稳定型心绞痛，入住我院。患者接受碘克沙醇重复心脏导管检查。第一次心脏导管检查后约 20 小时，患者上肢开始出现轻微震颤；患者意识清楚，但无法控制这些运动。在进行第二次心脏导管检查前共发生了 6 次发作，每次发作持续约 2 秒。这些症状未经治疗。第二次心脏导管检查后约 2 小时，症状加重，发作频率显著增加；第二次手术后 6 小时症状完全缓解。脑电图（EEG）显示弥漫性减慢伴癫痫样异常。双侧出现阵发性棘波和慢波放电，额区异常明显。这些观察结果提示患者癫痫发作。出院后 6 个月每月进行临床随访，均未发现神经科医生或心脏病专家有神经系统异常，且患者的脑电图正常。在此过程中未使用任何抗癫痫药物。
CIE，特别是复发性癫痫发作，是碘克沙醇心脏导管检查罕见但常可逆转的并发症。其症状可能较轻，因此容易被医生忽视。EEG 可早期发现 CIE。反复接触造影剂可能导致复发性癫痫发作。
