Savaş SARIKAYA, Asuman ÇELİKBİLEK, Ali Rıza ERBAY, Aylin OKUR

Koroner anjiyografi sonrası gelişen parsiyel amnezi: Olgu sunumu

Koroner anjiyografi (KAG) sonrası gelişen geçici amneziler literatürde tanımlanmıştır. Bu makalede, KAG sonrası akut izole amnezisi gelişen ve serebral görüntülemede sağ oksipital enfarkt saptanan bir olgu sunulmuştur. 58 yaşında sağ elli erkek hasta, istirahatta olan göğüs ağrısı şikâyeti ile hastanemize başvurdu. Hastaya stabil anjina pektoris ön tanısı ile KAG yapıldı. İşlem sırasında, intra-arteriyel iodiksanol (non-iyonik, dimerik) kontrast madde 300 cc dozunda kullanıldı. İşlemden yaklaşık beş dakika sonra hastada amnezi gelişti. Nörolojik muayenesinde, izole parsiyel retrograd amnezi dışında patoloji saptanmadı. Hastanın amnezisini açıklayacak işleme ait hemodinamik instabilite ve/veya kan parametrelerinde bozukluk saptanmadı. Hastamıza vasküler risk faktörleri taşıdığı için serebral görüntülenme yapıldı. Beyin ve diffüzyon manyetik rezonans görüntülenmede sağ oksipital lobda akut enfarkt izlendi. KAGden dört saat sonra hastanın amnezisi tamamen düzeldi. Bir hafta sonra tekrarlanan serebral görüntülemede sağ oksipital enfarkt alanının sebat ettiği izlendi ve kontrast maddeye bağlı bir etki olmadığı ortaya kondu. Olgumuzda gelişen amnezi, arteriyel vazospazma ve/veya katater manüplasyonuna sekonder embolik bir hadise olarak düşünülmüştür. Bu yazıda, çoğu zaman kontrast maddenin tetiklediği geçici nörotoksik bir etkiye bağlanarak ayrıntılı tetkik yapılmayan postanjiyografik amnezi vakalarında özellikle vasküler risk faktörleri taşıyan grupta- mutlaka serebral görüntülenmenin yapılması gerektiği vurgulanmıştır.

Partial amnesia following coroner angiography: A case report

Temporary amnesia following coronary angiography (CAG) has been described in the literature. In this paper, a case was presented with an acute isolated amnesia developed after CAG and right occipital infarct in cerebral imaging. Fifty-eight year-old right-handed male patient was admitted to our hospital with the complaint of chest pain at rest. CAG was performed on the patient with the diagnosis of stable angina pectoris. During the procedure, intra-arterial iodiksanol (non-ionic, dimeric) was used as a contrast medium at a dose of 300 cc. The patient developed amnesia in five minute after the procedure. Neurological examination revealed no abnormality except the isolated partial retrograde amnesia. There was no hemodynamic instability related to the procedure and / or aberrant blood parameters that could explain the amnesia. The patient underwent cerebral imaging because he had vascular risk factors. Brain and diffusion magnetic resonance imaging displayed an acute infarction in the right occipital lobe. The patient samnesia was completely improved in four hours after CAG. Right occipital infarction was persisted in cerebral imaging that was repeated after a week and thus an effect related to contrast medium was excluded. The amnesia in our case was considered as an embolic event secondary to arterial vasospasm and/or catheter manipulation. Here in, it is emphasized that cerebral imaging should be performed in the post-angiographic amnesic patients, those especially carrying vascular risk factors, in whom the etiology was mostly attributed to transient neurotoxic effect induced by the contrast agent without a detailed examination.

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