Subarachnoid Hyperdensity Following Aneurysm Embolization in Renal Failure

腎臟衰竭病患接受動脈瘤栓塞後在電腦斷層之蜘蛛網膜下腔高密度病灶影像表現

陳秀玲(Hsiu-Ling Chen) ； 郭葉璘(Yeh-Lin Kuo) ； 林偉哲(Wei-Che Lin)

《中華放射線醫學雜誌》 35卷1期 (2010/03) Pp. 27-32

摘要

在動脈瘤栓塞後發生之痙攣合併意識受損，並在電腦斷層看見不對稱之蜘蛛網膜下腔高密度病灶，可能是由於栓塞過程中併發動脈瘤破裂，或者是顯影劑造成之神經病變。我們報告一位患有末期腎病變之59歲女性，合併多發性的顱內動脈瘤並接受白金線圈栓塞。術後十四小時，病人發生痙攣現象併有意識受損。未顯影之電腦斷層顯示雙側瀰漫性蜘蛛網膜下腔之高亮度病灶，尤以左側額頂葉附近為主。病人接受緊急洗腎，其後追蹤電腦斷層顯示此病灶完全消失。在末期腎病患，動脈瘤栓塞術後早期洗腎是相當重要的，可以避免顯影劑導致神經病變，並且可與術後出血做一明確區分。

並列摘要

Post procedural seizure with impaired consciousness and asymmetric subarachnoid hyperattenuations on computed tomography (CT) scans suggests periprocedural perforation of an aneurysm or contrast material-induced encephalopathy (CMIE). We now report the case of a 59 year-old woman with a history of end-stage renal disease and multiple intracranial aneurysms who underwent embolization with Guglielmi detachable coils. Fourteen hours after the intervention, the patient had a general seizure, with subsequent impairment of consciousness. Non-enhanced CT scans revealed diffuse subarachnoid hyperattenuation, more prominent in the left frontoparietal region. The patient received emergency hemodialysis. Post-dialysis CT demonstrated complete resolution of the hyperattenuation. In patients with end-stage renal disease, early post-embolization hemodialysis is necessary to avoid contrast material-induced encephalopathy and to clarify the potentially confusing complication of procedural rebleeding.