Department of Neuroradiology, Hospital de Braga, Braga, Portugal.
Department of Neurology, Hospital de Braga, Braga, Portugal.
Acta Neurol Belg. 2020 Dec;120(6):1419-1424. doi: 10.1007/s13760-020-01508-x. Epub 2020 Sep 30.
Contrast-induced neurotoxicity (CIN) is an adverse reaction to contrast agents which can occur in the context of diagnostic and therapeutic neurological endovascular procedures. Our goal was to conduct a systematic review of patients reported in the literature diagnosed with CIN after neurological endovascular procedures. A systematic search of EMBASE and MEDLINE databases was conducted. Inclusion criteria were age ≥ 18 years; neurological endovascular procedure performed ≤ 24 h before ictus; new manifestations compatible with encephalic dysfunction; imaging performed < 7 days after ictus; exclusion of other causes and manifestations attributed to pre-existing conditions. Forty-eight patients were included, of which 60.4% were female and 60.4% had arterial hypertension; median age was 63 years. The most frequent procedure was diagnostic cerebral angiography (n = 24, 50.0%) and non-ionic contrast agents were more frequently used (n = 40, 83.3%). Twenty-six patients (54.2%) developed clinical manifestations compatible with CIN during or immediately after the procedure, and the most frequent manifestations were encephalopathy, cortical blindness and motor deficit. The most frequent imaging findings were cortical contrast enhancement on CT (n = 23/42), and cortical sulci effacement (n = 18/48). Most patients presented complete clinical recovery (89.6%) at a median time of 3 days. Among patients with neuroimaging changes who underwent follow-up, complete regression of the abnormalities was shown in 81.5% at a median time of 5 days. CIN is a rare adverse reaction in the context of neurological endovascular procedures. Recognition of clinical manifestations and typical imaging abnormalities, while excluding other causes, is essential for diagnosis.
对比剂诱导的神经毒性（CIN）是一种在诊断和治疗性神经血管内介入过程中发生的造影剂不良反应。我们的目标是对文献中报道的神经血管内介入术后诊断为 CIN 的患者进行系统回顾。对 EMBASE 和 MEDLINE 数据库进行了系统搜索。纳入标准为：年龄≥18 岁；神经血管内介入操作在卒中前 24 小时内进行；新出现的与脑功能障碍相符的表现；在卒中后 7 天内进行影像学检查；排除其他原因和与先前存在的疾病相关的表现。共纳入 48 例患者，其中 60.4%为女性，60.4%有动脉高血压；中位年龄为 63 岁。最常见的操作是诊断性脑动脉造影术（n=24，50.0%），更常使用非离子型造影剂（n=40，83.3%）。26 例（54.2%）患者在操作期间或操作后立即出现与 CIN 相符的临床表现，最常见的表现为脑病、皮质盲和运动障碍。最常见的影像学表现为 CT 上皮质对比增强（n=23/42）和皮质沟消失（n=18/48）。大多数患者在中位时间 3 天内完全恢复临床症状（89.6%）。在接受神经影像学随访的患者中，81.5%的患者在中位时间 5 天内显示异常完全消退。CIN 在神经血管内介入中是一种罕见的不良反应。识别临床表现和典型的影像学异常，同时排除其他原因，对诊断至关重要。
