脑动脉溶栓后颅内对比剂增强误诊为脑出血的临床分析

Intracranial contrast enhancement was misdiagnosed as cerebral hemorrhage after cerebral arterial thrombolysis and literature review

目的探讨动脉溶栓后颅内对比剂增强与脑出血的鉴别诊断。方法回顾性分析1例颈内动脉重度狭窄患者颈动脉支架植入术中的CT影像。结果术中发现患者大脑前和大脑中动脉闭塞,经动脉溶栓后开通,颅脑CT检查发现左侧基底节区高密度病灶。患者动态CT检查,发现术后72 h颅内高密度病灶消失,考虑为对比剂增强,排除了脑出血。分析误诊原因并总结治疗经验,结合文献分析动脉溶栓后颅内对比剂增强与脑出血的鉴别诊断。结论脑梗死患者动脉溶栓后可出现颅内对比剂增强,发生率较高,容易与脑出血混淆,临床医师应该提高认识,给予积极处理。

Objective To study the causes of high density focus in brain after intracranial arterial thrombolysis,and improve the identification of the intracranial contrast enhancement,cerebral hemorrhage conversion and reduce misdiagnosis.Methods The CT scan in carotid artery stenting of the patient artery stenting who with severe stenosis of internal carotid artery was retrospective analysis.Results Anterior and middle cerebral artery occlusion were found in the surgery.CT scan showed high density focus in left basal ganglia after arterial thrombolysis,and dynamic CT scan of brain was given after 72 hours.The intracranial high density lesions disappeared after 72 hours.And after the surgery cerebral hemorrhage was excluded and the contrast enhancement was considered.Conclusions The intracranial contrast enhancementartery in patients with cerebral infarction can be found frequently,and confused with cerebral hemorrhage.We should improve the understanding and give patients active treatment.