颈动脉支架成形术后造影剂脑病临床误诊分析  

Analysis of Clinical Misdiagnosis of Contrast-Induced Encephalopathy after Carotid Artery Stenting

作　　者：沙斐 武欣 安琪 李高彪 刘鸿涛 SHA Fei;WU Xin;AN Qi;LI Gaobiao;LIU Hongtao(Department of Vascular Surgery,Wangjing Hospital of China Academy of Chinese Medical Sciences,Beijing 100102,China)

机构地区：[1]中国中医科学院附属望京医院血管外科,北京100102

出　　处：《临床误诊误治》2024年第15期20-24,共5页Clinical Misdiagnosis & Mistherapy

基　　金：中国中医科学院科技创新工程(C12021A01905)。

摘　　要：目的分析颈动脉支架成形术(CAS)后造影剂脑病(CIE)的临床表现及早期误诊原因。方法对2020年9月至2024年4月收治的误诊的CAS后CIE 5例的临床资料进行回顾性分析。结果1例患者术后2 h出现进行性意识障碍、混合性失语、双侧瞳孔对光反射迟缓和右侧肢体无力,术后7 h出现高热、癫痫发作、偏瘫,结合CT检查误诊为蛛网膜下腔出血;4例患者于术后2~6 h出现了急性失语及偏瘫,结合CT检查误诊为腔隙性脑梗死。5例患者均给予相应治疗后复查头颅CT确诊CIE。误诊时间12~48 h。治疗后急性失语及偏瘫症状均得到改善,未再出现意识障碍及癫痫发作。结论CAS术后CIE症状常不典型,极易误诊,临床医师应全面分析病情,及时排除原发神经系统疾病。Objective To analyze the clinical manifestations and causes of early misdiagnosis of contrast-induced encephalopathy(CIE)after carotid artery stenting(CAS).Methods A retrospective analysis was conducted on the clinical data of 5 patients with CIE misdiagnosed after CAS treated from September 2020 to April 2024.Results One patient developed progressive consciousness disorders,mixed aphasia,bilateral delayed pupillary light reflex,and right-sided limb weakness at 2 h after surgery.High fever,epileptic seizures,and hemiplegia occurred at 7 h after surgery,which were misdiagnosed as subarachnoid hemorrhage based on CT examination.Four patients developed acute aphasia and hemiplegia at 2-6 h postoperatively,which were misdiagnosed as lacunar cerebral infarction based on CT examination.All 5 patients received corresponding treatment and were confirmed to have CIE through follow-up head CT scans.The misdiagnosis lasted 12-48 h.After treatment,the symptoms of acute aphasia and hemiplegia were improved,and there were no consciousness disorders or epileptic seizures.Conclusion CIE symptoms after CAS are often atypical and it is prone to misdiagnosis.Clinicians should analyze the condition comprehensively,to promptly rule out primary neurological disorders.

关 键 词：造影剂脑病 颈动脉支架成形术 误诊 腔隙性脑梗死 蛛网膜下腔出血 诊断 鉴别 体层摄影术 螺旋计算机 

分 类 号：R743.9[医药卫生—神经病学与精神病学]