碘海醇致颅神经损伤误诊报告并文献复习  

Misdiagnosis Report of Cranial Nerve Impairment Caused by Iohexol and Literature Review

作　　者：周芝文[1] 周文胜[1] 杨剑文[1] 李爱平 魏伟 任翔 ZHOU Zhi-wen;ZHOU Wen-sheng;YANG Jian-wen;LI Ai-ping;WEI Wei;REN Xiang(Department of Neurology,Hunan Provincial People's Hospital,the First Affiliated Hospital of Hunan Normal University,Changsha 410016,China)

机构地区：[1]湖南省人民医院湖南师范大学附属第一医院神经内科

出　　处：《临床误诊误治》2020年第2期13-17,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨碘海醇致颅神经损伤临床特点、诊治要点及误诊原因、防范措施。方法回顾分析碘海醇致颅神经损伤2例的临床资料,并复习相关文献。结果 2例均为女性,分别因蛛网膜下腔出血和脑梗死采用碘海醇造影行神经介入治疗。术后均急起瞳孔散大、眼球活动障碍及眼球肿胀等,1例误诊为脑疝,1例未能明确诊断,均予甘露醇脱水治疗,效果不佳。后经完善头颅CT和MRI检查后,考虑碘海醇致颅神经损伤,予糖皮质激素等治疗后,均病情好转出院。结论采用碘海醇造影介入治疗后患者出现颅神经损伤,需考虑碘海醇不良反应,要及时完善相关医技检查,以减少或避免其误诊误治,并积极正确处理,以防止病情恶化。Objective To investigate the clinical features,diagnostic and therapeutic methods,causes of misdiagnosis and preventive measures of cranial nerve impairment caused by iohexol. Methods Clinical data of 2 patients with cranial nerve impairment caused by iohexol was retrospectively analyzed, and related literature was reviewed. Results Both patients were females, one with subarachnoid hemorrhage,and the other with acute cerebral infarction. Because of the neurological interventional therapy with iohexol,two patients had dilated pupils, dysfunction of the eyeballs, and swelling of the eyeballs after operation. One patient was misdiagnosed as cerebral palsy,and the other was not diagnosed. Both were treated with mannitol dehydration, with poor results. After a CT or MRI scan of the head,the cranial nerve impairment caused by iohexol was considered, and both of the patients were treated with glucocorticoid. The patients were discharged after the condition was improved. Conclusion When patients presented with cranial nerve impairment after interventional treatment with iohexol, the adverse reactions of iohexol need to be considered. Meanwhile, relevant medical examinations should be performed timely to reduce or avoid misdiagnosis and mistreatment, and active and correct management is needed to prevent the disease from worsening.

关 键 词：碘海醇 神经介入治疗 药物毒性 颅神经损伤 误诊 脑疝 

分 类 号：R745.1[医药卫生—神经病学与精神病学]