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急性大脑中动脉闭塞反复经皮腔内血管成形术后造影剂诱发脑病一例报告

A Case Report of Contrast-Induced Encephalopathy after Repeated Percutaneous Transluminal Angioplasty for Acute Middle Cerebral Artery Occlusion.

作者信息

Otsubo Haruki, Yoshie Tomohide, Araga Takashi, Tatsuno Kentaro, Takaishi Satoshi, Usuki Noriko, Yoshida Yasuyuki, Ono Hajime, Ueda Toshihiro

机构信息

Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan.

出版信息

J Neuroendovasc Ther. 2022;16(7):371-375. doi: 10.5797/jnet.cr.2021-0061. Epub 2021 Oct 9.

DOI:10.5797/jnet.cr.2021-0061
PMID:37502340
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10370915/
Abstract

OBJECTIVE

We report a case of contrast-induced encephalopathy (CIE) after repeated percutaneous transluminal angioplasty (PTA) for acute middle cerebral artery (MCA) occlusion.

CASE PRESENTATION

An 88-year-old woman with left hemiparesis was transferred to our hospital by ambulance. MRI revealed acute MCA M1 occlusion. We performed intravenous tissue plasminogen activator therapy and PTA for right MCA occlusion, leading to complete recanalization and improvement in hemiparalysis. After approximately one week, restenosis of right MCA developed and PTA was performed again on day 11. However, her left hemiparesis exacerbated shortly thereafter. CT demonstrated leakage of contrast medium, and an extensive high-intensity area (HIA) on the white matter in the right cerebral hemisphere was noted on MRI FLAIR. The HIA on MRI and neurological deficits gradually improved after conservative treatment, but diffuse atrophy of the right cerebral hemisphere occurred and higher brain dysfunction remained.

CONCLUSION

Repeated ischemia and reperfusion, and the frequent use of contrast media were considered the causes of CIE.

摘要

目的

我们报告一例在急性大脑中动脉（MCA）闭塞后反复进行经皮腔内血管成形术（PTA）后发生的对比剂诱导性脑病（CIE）病例。

病例介绍

一名88岁左侧偏瘫女性患者由救护车转送至我院。MRI显示急性MCA M1段闭塞。我们对右侧MCA闭塞进行了静脉注射组织纤溶酶原激活剂治疗及PTA，实现了完全再通并使偏瘫症状改善。大约一周后，右侧MCA出现再狭窄，并于第11天再次进行PTA。然而，此后不久她的左侧偏瘫加重。CT显示造影剂渗漏，MRI液体衰减反转恢复序列（FLAIR）显示右侧大脑半球白质有广泛的高强度区域（HIA）。经保守治疗后，MRI上的HIA及神经功能缺损逐渐改善，但右侧大脑半球出现弥漫性萎缩且高级脑功能障碍仍然存在。

结论

反复的缺血再灌注以及造影剂的频繁使用被认为是CIE的病因。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4a71/10370915/4d77b407aafb/jnet-16-371-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4a71/10370915/6aa68748eaf2/jnet-16-371-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4a71/10370915/6944ebe74064/jnet-16-371-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4a71/10370915/03e98bb829c7/jnet-16-371-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4a71/10370915/71e175f109ec/jnet-16-371-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4a71/10370915/4d77b407aafb/jnet-16-371-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4a71/10370915/6aa68748eaf2/jnet-16-371-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4a71/10370915/6944ebe74064/jnet-16-371-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4a71/10370915/03e98bb829c7/jnet-16-371-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4a71/10370915/71e175f109ec/jnet-16-371-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4a71/10370915/4d77b407aafb/jnet-16-371-g005.jpg

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