Mattiotti Maria, Milan Manani Sabrina, Gnappi Maddalena, Virzì Grazia Maria, Marcello Matteo, Marturano Davide, Tantillo Ilaria, Giuliani Anna, La Manna Gaetano, Ronco Claudio, Zanella Monica
Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.
Nephrology, Dialysis and Transplant Unit, IRCCS Policlinico Sant'Orsola, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
G Ital Nefrol. 2023 Oct 26;40(5):2023-vol5.
Contrast Induced Encephalopathy (CIE) belongs to Major Adverse Renal and Cardiovascular Events (MARCE) after iodinated contrast medium (IOCM), especially for high-risk patients with several comorbidities such as hypertension, diabetes, heart failure, and Chronic Kidney Disease (CKD). We report a case of CIE in a Peritoneal Dialysis (PD)-patient. A 78-year-old, affected by diabetes, hypertension, chronic heart failure, and End Stage Renal Disease (ESRD) treated with PD, underwent a carotid Percutaneous Angioplasty (PTA). Immediately after the exam, he developed mental confusion and aphasia. Encephalic CT scan and MRI excluded acute ischemia or hemorrhage but showed cerebral oedema. Mannitol and steroids were administered and additional PD exchange was performed with depurative aim. Within 2 days the patient completely recovered. CIE mimics severe neurological diseases. It should be considered as a differential diagnosis if symptoms occur immediately after administration of IOCM, especially in high-risk patients and in case of intra-arterial injection. Clinical presentation includes transient cortical blindness, aphasia, focal neurological defects, and confusion. CIE is often a diagnosis of exclusion, and imaging plays a significant role. Symptoms generally resolve spontaneously within 24-48h, rarely in few days. Symptomatic therapy, including mannitol and steroids could be considered. In literature, CIE is reported only in a few patients affected by ESRD treated with chronic HD, and our is the first available case of a patient treated with chronic PD who developed this rare complication.
对比剂诱导的脑病（CIE）属于碘造影剂（IOCM）使用后的主要不良肾和心血管事件（MARCE），尤其对于患有多种合并症（如高血压、糖尿病、心力衰竭和慢性肾脏病（CKD））的高危患者。我们报告一例腹膜透析（PD）患者发生CIE的病例。一名78岁男性，患有糖尿病、高血压、慢性心力衰竭和接受PD治疗的终末期肾病（ESRD），接受了颈动脉经皮血管成形术（PTA）。检查后立即出现精神错乱和失语。头颅CT扫描和MRI排除了急性缺血或出血，但显示有脑水肿。给予甘露醇和类固醇治疗，并进行了旨在净化的额外PD交换。患者在2天内完全康复。CIE可模拟严重的神经系统疾病。如果在注射IOCM后立即出现症状，尤其是在高危患者和动脉内注射的情况下，应考虑将其作为鉴别诊断。临床表现包括短暂性皮质盲、失语、局灶性神经功能缺损和精神错乱。CIE通常是一种排除性诊断，影像学起重要作用。症状一般在24 - 48小时内自行缓解，很少在数天内缓解。可考虑采用包括甘露醇和类固醇在内的对症治疗。在文献中，CIE仅在少数接受慢性血液透析治疗的ESRD患者中报道过，而我们的病例是首例接受慢性PD治疗的患者发生这种罕见并发症的病例。
