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[A case of suspected cholesterol embolism]
Kiyotaka Sato1, Hiroaki Shimizu, Masato Kato
1Department of Neuroanesthesia, Kohnan Hospital, Sendai 982-8523.
Masui. the Japanese Journal of Anesthesiology
|March 14, 2002
Summary
This case highlights cholesterol embolism syndrome, a rare complication of angiography, presenting with multi-organ issues including brain stem infarction and mesenteric artery thromboembolism. Prompt recognition and management are crucial for patient outcomes.
Area of Science:
- Vascular Medicine
- Nephrology
- Neurology
- Surgical Anesthesia
Background:
- Cerebral angiography is a diagnostic tool for cerebrovascular diseases.
- Severe bilateral internal carotid artery stenosis can lead to brain stem infarction.
Observation:
- A patient undergoing angiography for brain stem infarction developed acute abdominal pain, diagnosed as superior mesenteric artery thromboembolism.
- Following conservative treatment, the patient experienced worsening renal function and blue toe, suggesting cholesterol embolism.
Findings:
- Cholesterol embolism syndrome was suspected, leading to discontinuation of thrombolytic therapy and initiation of steroid administration and LDL-apheresis.
- Despite interventions, renal function continued to decline, necessitating hemodialysis.
Implications:
- Neuroanesthesiologists must be aware of cholesterol embolism as a potential perioperative complication, especially after angiography.
- Early diagnosis and multidisciplinary management are vital for patients presenting with multi-systemic signs of cholesterol embolism.