同位素鉈^(201)心肌灌注造影時靜脈注射Dipyridamole引發可逆性神經學併發症一病例報告

Reversible Neurological Complications Induced by Intravenous Dipyridamole During Thallium^(201) Myocardial Scintigraphy: A Case Report

周伯翰(Po-Han Chou) ； 張博淵(Po-Yuan Chang)

《北市醫學雜誌》 13卷3期 (2016/09) Pp. 176-182

https://doi.org/10.6200/TCMJ.2016.13.3.18

摘要

同位素鉈^(201)- 心肌灌注造影(Thallium^(201) Myocardial Perfusion Imaging)在評估心肌缺氧之嚴重度及診斷冠狀動脈疾病佔有重要角色。因身體狀況不佳而無法施行運動測試(exercise-stress Thallium^(201)) 的病人可以選擇注射dipyridamole 引發心肌壓力之後進行造影(Dipyridamole-stress Thallium^(201))，其準確性相近也相對安全。然而，注射dipyridamole 之後有一些病人會產生頭暈、頭痛等輕微的副作用，嚴重副作用如中風的發生率雖然極低，一旦發生卻可能致命。本文報告一名76歲女性病人在接受Dipyridamole-Thallium^(201)影像檢查時產生暫時性知覺喪失及運動障礙(transient ischemic attack; TIA)的個案，應是注射dipyridamole 所引起的嚴重神經併發症。我們藉由文獻回顧，探討同位素鉈^(201)- 心肌灌注造影(Thallium-201 Myocardial Perfusion Imaging)所潛在的腦中風危險並提出相關建議。

關鍵字

同位素鉈201- 心肌灌注造影 ； 暫時性腦部缺氧 ； 冠心病

並列摘要

Thallium^(201) myocardial scintigraphy is the cornerstone of evaluation of myocardial ischemia and infarct. Thallium^(201) imaging after dipyridamole stress can be used as an alternative for patients not suitable for exercise stress, and the diagnostic accuracy and safety are comparable. Although minor side effects such as headache and dizziness may occur with dipyridamole injection, major neurological complications such as transient ischemic attack (TIA) or stroke are rare. We report here a 76-year-old female with hypertension, hyperlipidemia, and coronary artery disease who suffered a transient ischemic attack after administration of intravenous dipyridamole during Thallium^(201) test. Complete neurological recovery suggested reversibl e dipyridamole- induced neurological deficits. Through literature review, we discuss the potential side effects of dipyridamole and raise an important issue concerning neurological complications encountered in Dipyridamole-Thallium^(201) myocardial scintigraphy.

並列關鍵字

Thallium^(201) Myocardial Perfusion Imaging ； Dipyridamole ； Transient ischemic attack ； Coronary Artery Disease