Elsadany Mohammed, McMahon Sean R, Mehla Sandhya, Duvall W Lane
Division of Cardiology, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA.
Department of Neurology, Hartford Hospital, Hartford, CT, USA.
J Nucl Cardiol. 2022 Dec;29(6):3469-3473. doi: 10.1007/s12350-021-02736-1. Epub 2021 Jul 25.
SPECT and PET myocardial perfusion imaging (MPI) are widely used to evaluate patients for coronary artery disease. Regadenoson (a selective A adenosine receptor agonist) is a commonly used vasodilator agent for stress MPI because of its safety profile and ease of use. Common adverse reactions such as headache, shortness of breath, flushing, and chest and abdominal discomfort are typically mild and can be effectively reversed using methylxanthines such as aminophylline and caffeine. Neurological adverse reactions such as seizure and stroke have rarely been reported with the use of regadenoson. The hemodynamic changes associated with regadenoson administration, such as an exaggerated hypotensive or hypertensive response, may be the cause for the reported cerebrovascular accidents. Activation of central nervous system A adenosine receptors is thought to be responsible for seizure episodes in patients with or without known histories of seizure. A adenosine receptors activation is also believed to play a role in headaches and migraine. This patient reported who has a history of hemiplegic migraine developed left side weakness and headache following the administration of regadenoson during a PET MPI study. Imaging work-up to rule out cerebrovascular accident was normal. After 1 hour from the onset of his symptoms, his weakness and headache significantly improved with complete resolution within 24 hours. We concluded that regadenoson triggered a hemiplegic migraine episode in this patient, which has not been previously reported in the literature. It may be prudent to avoid regadenoson and adenosine use in patients with a history of hemiplegic migraine.
单光子发射计算机断层扫描（SPECT）和正电子发射断层扫描（PET）心肌灌注成像（MPI）被广泛用于评估冠状动脉疾病患者。瑞加腺苷（一种选择性A腺苷受体激动剂）因其安全性和易用性，是应激MPI常用的血管扩张剂。常见的不良反应如头痛、呼吸急促、脸红以及胸部和腹部不适通常较轻，使用氨茶碱和咖啡因等甲基黄嘌呤类药物可有效逆转。使用瑞加腺苷很少报告有癫痫发作和中风等神经不良反应。与瑞加腺苷给药相关的血流动力学变化，如过度的低血压或高血压反应，可能是所报告的脑血管意外的原因。中枢神经系统A腺苷受体的激活被认为是有或无癫痫病史患者癫痫发作的原因。A腺苷受体激活也被认为在头痛和偏头痛中起作用。该患者有偏瘫性偏头痛病史，在PET MPI研究期间给予瑞加腺苷后出现左侧无力和头痛。排除脑血管意外的影像学检查结果正常。症状出现1小时后，其无力和头痛明显改善，并在24小时内完全缓解。我们得出结论，瑞加腺苷在该患者中引发了偏瘫性偏头痛发作，这在文献中此前未见报道。对于有偏瘫性偏头痛病史的患者，避免使用瑞加腺苷和腺苷可能是谨慎的做法。
