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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Fatal Brain Injury Following Carbon Dioxide Angiography
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Fatal Brain Injury Following Carbon Dioxide Angiography

机译：二氧化碳血管造影后致命的脑损伤

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Introduction: Carbon dioxide (CO2) as a contrast agent has been in use as early as the 1920s for visualization of retroperitoneal structures. Digital subtraction angiography (DSA) using CO2 as a contrast agent for vascular imaging was developed in the 1980s. Currently, CO2 angiography is an alternative agent in patients with chronic kidney disease (CKD) and those who are at risk of developing contrastinduced nephropathy. However, CO2 causes neurotoxicity if the gas inadvertently enters the cerebrovascular circulation leading to fatal brain injury. Case presentation: A 71-year-old female with h/o sickle cell trait, hypertension, obesity, metastatic renal cell cancer status post nephrectomy, bone metastasis, chronic kidney disease was admitted for elective embolization of the humerus bone metastasis. Given the high probability of contrast-induced nephropathy, CO2 angiography was chosen for embolization of the metastasis. During the procedure, the patient became unresponsive. Emergent medical management with hyperventilation, 100% fraction oxygen inhalation was performed. Her neuroimaging showed global cerebral edema. An intracranial pressure monitor was placed which confirmed intracranial hypertension. Hyperosmolar therapy was administered with no improvement in clinical examination. She progressed to brain stem herniation. Given poor prognosis, the family opted for comfort measures and the patient expired. Discussion and Conclusions: Inadvertent carbon dioxide entry into cerebrovascular circulation during angiography can cause fatal brain injury. Caution must be exercised while performing CO2 angiography in blood vessels above the diaphragm.
机译：简介：二氧化碳（CO2）作为对比剂早在20世纪20年代就被用于腹膜后结构的可视化。数字减影血管造影（DSA）是20世纪80年代发展起来的，使用CO2作为血管成像的对比剂。目前，CO2血管造影术是慢性肾病（CKD）患者和有发生造影剂诱发肾病风险的患者的替代药物。然而，如果二氧化碳无意中进入脑血管循环，导致致命的脑损伤，则会导致神经毒性。病例介绍：一名71岁女性，患有h/o镰状细胞特征、高血压、肥胖、肾切除术后转移性肾细胞癌、骨转移、慢性肾病，因选择性肱骨转移栓塞入院。考虑到造影剂诱发肾病的可能性很高，选择CO2血管造影栓塞转移灶。在手术过程中，病人没有反应。紧急医疗管理与过度换气，100%分数吸氧进行。她的神经影像显示全脑水肿。放置颅内压监测器，确认颅内高压。高渗治疗在临床检查中没有改善。她发展成脑干突出症。考虑到预后不佳，这家人选择了舒适的措施，病人就去世了。讨论和结论：在血管造影过程中，无意中二氧化碳进入脑血管循环可导致致命的脑损伤。在横膈膜上方的血管中进行CO2血管造影时必须小心。

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