Encephalopathy and rhabdomyolysis induced by iotrolan during epiduroscopy
Encephalopathy and rhabdomyolysis induced by iotrolan during epiduroscopy
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DOI：
10.1007/bf03021899
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发表时间：
2007-01-01
期刊：
影响因子：
--
通讯作者：
Hanaoka, Kazuo
中科院分区：
文献类型：
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作者：
Mizuno, Ju;Gauss, Tobias;Hanaoka, Kazuo
目的：我们描述了与造影剂碘曲兰相关的脑病和横纹肌溶解的硬膜外镜并发症。临床特征：76岁男性背部手术综合征失败行硬膜外镜检查。由于致密粘连和瘢痕组织，L层以上的硬膜外腔不能充分溶解。在硬膜外注射碘曲兰和甲哌卡因后，患者出现运动无力和双腿感觉减退，持续3小时。他还变得神志不清、烦躁不安、迷失方向、颈部僵硬、头部和腿部震颤。计算机断层扫描显示颅内脑脊液（CSF）间隙弥漫性增强，提示术中硬脑膜撕裂。血清肌酐、磷酸激酶和肌红蛋白的显著升高表明随后出现急性横纹肌溶解。晶体输注和半卧位有利于碘曲兰从脑脊液吸收，患者顺利康复。结论：硬膜外镜检查时的硬脑膜撕裂可能允许造影剂进入脑脊液。脑脊液中继发于碘曲兰的神经毒性可能是脑病和随后的横纹肌溶解的一个因素。这是一个有指导意义的例子，说明在使用碘曲兰的情况下，在硬膜外镜检查中诊断无意的硬脑膜撕裂的重要性，以避免诸如脑病和横纹肌溶解等不良事件。
Purpose: We describe a complication of epiduroscopy with encephalopathy and rhabdomyolysis associated with the contrast medium iotrolan.Clinical features: A 76-yr-old man with failed back surgery syndrome underwent epiduroscopy. Sufficient lysis could not be achieved in the epidural space above the level of L, due to dense adhesions and scar tissue. After epidural injections of iotrolan and mepivacaine, he developed motor weakness and hypoesthesia in both legs, which lasted for three hours. He also became confused, agitated, disoriented, and developed neck stiffness and tremors involving the head and legs. Computed tomography revealed diffuse contrast enhancement within the intracranial cerebrospinal fluid (CSF) spaces, indicating an intraoperative dural tear. Marked increases in serum creatinine phosphokinase and myoglobin indicated subsequent acute rhabdomyolysis. Crystalloid infusion and semi-recumbent positioning facilitated iotrolan absorption from the CSF, and the patient recovered uneventfully.Conclusions: Dural tear during epiduroscopy may allow access of contrast media into the CSF Neurotoxicity secondary to iotrolan within the CSF was a likely contributing factor to the encephalopathy and subsequent rhabdomyolysis. This is an instructive example of the importance of diagnosing inadvertent dural tear during epiduroscopy under iotrolan, for avoidance of adverse events such as encephalopathy and rhabdomyolysis.