以脑膜脑炎形式起病的造影剂脑病1例

Contrast media encephalopathy in the form of meningoencephalitis:one case report

目的探讨并总结介入手术围手术期关于造影剂脑病的预防、早期诊断和治疗经验。方法总结潍坊市中医院2019年9月收治的1例以脑膜脑炎形式起病的造影剂脑病病人的诊疗方案。结果男,58岁,头晕5 h入院,1月前颅脑磁共振血管成像(MRA)示右侧椎动脉开口处显影不清。此次入院急诊行全脑血管造影术,术中应用造影剂碘克沙醇注射液(碘离子浓度270 g/L)200 mL;术后出现烦躁不安,神经系统查体示脑膜刺激征及双侧椎体束损害,通过腰椎穿刺检查排除脑膜脑炎,诊断造影剂脑病,经补液水化及对症治疗后症状好转。结论造影剂脑病的早期诊断、及时治疗,可减少不可逆性损坏及严重不良预后的发生;同时要有造影剂脑病的预防理念,以减少造影剂脑病的发生。

Objective To summarize the prevention,early diagnosis and treatment of contrast-induced encephalopathy during the peri-operative period of interventional operation.Methods The diagnosis and treatment of a case of contrast-induced encephalopathy which occured in the form of meningoencephalitis who admitted to Weifang Hospital of Traditional Chinese Medicine in September 2019 were summarized.Results The patient was 58 years old and admitted to the hospital for dizziness for 5 hours.Magnetic resonance angiography(MRA)of the brain one month ago revealed that the opening of the right vertebral artery was unclear.Patient was performed whole brain angiography in this emergency admission,and 200 mL of the contrast agent iodixanol injection(270 g/L iodide ion concentration)was used during the operation.However,the patient was agitated after the operation,neurological examination revealed meningeal irritation and bilateral vertebral tract damage.Meningoencephalitis was ruled out by lumbar puncture and contrast agent encephalopathy was diagnosed,and these symptoms improved after rehydration and symptomatic treatment.Conclusions Early diagnosis and timely treatment of contrast-induced encephalopathy can reduce the occurrence of irreversible damage and severe adverse prognosis.At the same time,we should have the awareness of prevention of contrast-induced encephalopathy to reduce its incidence.