From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Chicago, IL 60612.
Radiology. 2023 Dec;309(3):e222747. doi: 10.1148/radiol.222747.
A 69-year-old right-handed man with a history of substance use disorder, hypertension, and diabetes presented to the emergency department in an unresponsive state. Upon examination, apart from tachycardia (heart rate, 108 beats per minute), vital signs were within normal ranges (blood pressure, 134/102 mm Hg; temperature, 97.9°F [36.6°C]; respiratory rate, 16 breaths per minute; oxygen saturation, 96%). He had a Glasgow coma scale score of 8. Otherwise, the physical examination revealed no abnormalities. His prior psychiatric and surgical histories were unremarkable. There was no history of recent travel, camping, hiking, or vaccination. No family history could be obtained. Laboratory work-up revealed an elevated creatine kinase level (49 006 U/L [818.4 μkat/L]; normal reference range, 10-205 U/L [0.17-3.42 μkat/L]). An electrocardiogram showed sinus tachycardia without evidence of cardiac ischemia. An echocardiogram was unremarkable. Alanine aminotransferase (126 U/L [2.10 μkat/L]; normal reference range, 0-40 U/L [0-0.67 μkat/L]) and aspartate aminotransferase (488 U/L [8.15 μkat/L]; normal reference range, 3-44 U/L [0.05-0.74 μkat/L]) levels were elevated. Polymerase chain reaction results were negative for HIV-1, HIV-2, syphilis treponemal, and COVID-19 antibodies. The rest of the routine laboratory work-up findings were within normal limits. Urine drug screening was positive for cocaine, marijuana, fentanyl, and benzodiazepines. Naloxone was administered, but the patient remained unresponsive. Intubation was performed for airway protection. Noncontrast and contrast-enhanced CT of the head (Fig 1) and CT angiography were performed in the emergency department to rule out an acute intracranial abnormality. Multisequence MRI of the brain with administration of intravenous contrast material was ordered for further assessment (Figs 2-4). CT of the abdomen and pelvis was unremarkable (images not shown).
一位 69 岁的右利手男性，有物质使用障碍、高血压和糖尿病病史，因意识不清状态被送至急诊部。检查时，除心动过速（心率 108 次/分）外，生命体征均在正常范围内（血压 134/102mmHg；体温 97.9°F [36.6°C]；呼吸频率 16 次/分；血氧饱和度 96%）。他的格拉斯哥昏迷评分（Glasgow coma scale score）为 8 分。体格检查未见其他异常。他既往的精神病史和手术史无特殊。无近期旅行、露营、徒步旅行或疫苗接种史。无法获得家族病史。实验室检查结果显示肌酸激酶水平升高（49006U/L [818.4μkat/L]；正常值范围 10-205U/L [0.17-3.42μkat/L]）。心电图显示窦性心动过速，无心肌缺血证据。超声心动图无异常。丙氨酸氨基转移酶（126U/L [2.10μkat/L]；正常值范围 0-40U/L [0-0.67μkat/L]）和天门冬氨酸氨基转移酶（488U/L [8.15μkat/L]；正常值范围 3-44U/L [0.05-0.74μkat/L]）升高。聚合酶链反应（polymerase chain reaction）结果为 HIV-1、HIV-2、梅毒螺旋体和 COVID-19 抗体阴性。其余常规实验室检查结果均在正常范围内。尿液药物筛查结果可卡因、大麻、芬太尼和苯二氮䓬类药物阳性。给予纳洛酮，但患者仍无反应。为保护气道进行了气管插管。为排除急性颅内异常，在急诊部进行了头部非增强和增强 CT 以及 CT 血管造影检查（图 1）。为进一步评估，安排了脑多序列 MRI 检查，静脉注射造影剂（图 2-4）。腹部和骨盆 CT 未见异常（未显示图像）。
