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Yildirim U, Kara A, Uyanik M, Kocasari AO, Cinar A, Coksevim M, Avci B, Soylu K, Gulel O. Evaluation of silent brain injury in patients undergoing aorto-ostial coronary stent implantation. Ann Med 2024; 56:2402950. [PMID: 39268588 PMCID: PMC11404371 DOI: 10.1080/07853890.2024.2402950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 04/30/2024] [Accepted: 06/06/2024] [Indexed: 09/17/2024] Open
Abstract
BACKGROUND Aorto-ostial (AO) coronary interventions may be associated with multiple problems, including the potential embolization of atherothrombotic debris into the aorta and systemic circulation. Such embolization could theoretically lead to stroke or silent brain injury (SBI). In this study, we aimed to investigate whether there is an increased risk of SBI in patients undergoing AO stent implantation. METHODS Fifty-five consecutive patients undergoing AO stenting and 55 consecutive patients undergoing non-AO stenting were included. Venous blood samples were obtained before and 12 h after the procedure to measure neuron-specific enolase (NSE), which is a sensitive marker of brain injury. Newly developed NSE elevation after the procedure in an asymptomatic patient was defined as SBI. RESULTS SBI was detected in 24 (43.6%) patients in the AO stenting group and 17 (30.9%) patients in the non-AO stenting group (p = .167). Although the SBI rates were statistically comparable between the groups, the presence of significant (≥50%) AO stenosis was found to be an independent predictor of SBI in multivariate logistic regression analysis [odds ratio (OR) 2.856; 95% confidence interval (CI) 1.057-7.716; p = .038]. A longer procedure time was another independent predictor for the development of SBI (OR 1.037; 95% CI 1.005-1.069; p = .023). CONCLUSION This study suggests that AO stenting may be associated with an increased risk of SBI if the lesion in the ostium is significant.
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Affiliation(s)
- Ufuk Yildirim
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Abdulkadir Kara
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Muhammet Uyanik
- Department of Cardiology, Carsamba State Hospital, Samsun, Turkey
| | - Ahmet Onur Kocasari
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ahmet Cinar
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Metin Coksevim
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Bahattin Avci
- Department of Biochemistry, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Korhan Soylu
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Okan Gulel
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Xu SY, Song MM, Liu DY, Li CX, Xue LX, Li Y. Contrast-induced encephalopathy with significantly elevated levels of cerebrospinal fluid protein. Br J Neurosurg 2024; 38:963-967. [PMID: 34435533 DOI: 10.1080/02688697.2021.1970113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/09/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
Contrast-induced encephalopathy (CIE) is a rare complication of angiography. According to our knowledge, the majority of CIE reports is imaging observations and rarely includes results of cerebrospinal fluid (CSF) tests. Furthermore, among the cases reporting the data for CSF testing, most of the results were normal. Here, we report a case of CIE presenting with significantly elevated levels of CSF protein. We found that the course of improvement in brain imaging findings was not consistent with the severity of clinical manifestations. The diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) sequences were normal. Considering the lack of convenient direct indicators to observe blood-brain barrier (BBB) function, changes in the levels of CSF protein may be related to BBB permeability and recovery and may serve as a potential prognostic marker.
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Affiliation(s)
- Sui-Yi Xu
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Mao-Mei Song
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Dong-Yuan Liu
- Department of Neurology, Yanhu District Branch, The First Hospital of Shanxi Medical University, Yuncheng, China
| | - Chang-Xin Li
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Li-Xi Xue
- Department of Neurology, Yanhu District Branch, The First Hospital of Shanxi Medical University, Yuncheng, China
| | - Yang Li
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Neurology, Yanhu District Branch, The First Hospital of Shanxi Medical University, Yuncheng, China
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3
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Sallustio F, Nicolini E, Saia V, Pracucci G, Mascolo AP, Marrama F, Gandini R, Da Ros V, Diomedi M, Alemseged F, Casetta I, Fainardi E, Castellan L, Del Sette M, Limbucci N, Nencini P, Bergui M, Cerrato P, Saletti A, De Vito A, Cioni S, Tassi R, Simonetti L, Zini A, Ruggiero M, Longoni M, Tessitore A, Ferraù L, Cavasin N, Critelli A, Vallone S, Bigliardi G, Zimatore DS, Petruzzellis M, Boghi A, Naldi A, Comai A, Dall'Ora E, Sanfilippo G, Persico A, Gallesio I, Sepe F, Menozzi R, Pezzini A, Besana M, Giossi A, Sanna A, Tassinari T, Burdi N, Boero G, Augelli R, Cappellari M, Cosottini M, Giannini N, Romano DG, Frauenfelder G, Nuzzi PN, Spinelli MC, Paladini A, Rizzo A, Filizzolo M, Mannino M, Timpani C, De Santis F, Carità G, Russo M, Galvano G, Sicurella L, Mangiafico S, Toni D. Association between procedural time and outcome in unsuccessful mechanical thrombectomy for acute ischemic stroke: analysis from the Italian Registry of Endovascular Treatment in Acute Stroke. J Neurol 2024; 271:5203-5212. [PMID: 38836906 DOI: 10.1007/s00415-024-12458-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/07/2024] [Accepted: 05/17/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND We aim to assess the association between procedural time and outcomes in patients in unsuccessful mechanical thrombectomy (MT) for anterior circulation acute stroke. METHODS We conducted a cohort study on prospectively collected data from patients with M1 and/or M2 segment of middle cerebral artery occlusion with a thrombolysis in cerebral infarction 0-1 at the end of procedure. Primary outcome was 90-day poor outcome. Secondary outcomes were early neurological deterioration (END), symptomatic intracranial hemorrhage (sICH) according to ECASS II and sICH according to SITS-MOST. RESULTS Among 852 patients, after comparing characteristics of favourable and poor outcome groups, logistic regression analysis showed age (OR: 1.04; 95%CI: 1.02-1.05; p < 0.001), previous TIA/stroke (OR: 0.23; 95%CI: 0.12-0.74; p = 0.009), M1 occlusion (OR: 1.69; 95%CI: 1.13-2.50; p = 0.01), baseline NIHSS (OR: 1.01; 95%CI: 1.06-1.13; p < 0.001) and procedural time (OR:1.00; 95% CI: 1.00-1.01; p = 0.003) as independent predictors poor outcome at 90 days. Concerning secondary outcomes, logistic regression analysis showed NIHSS (OR:0.96; 95%CI: 0.93-0.99; p = 0.008), general anaesthesia (OR:2.59; 95%CI: 1.52-4.40; p < 0.001), procedural time (OR: 1.00; 95% CI: 1.00-1.01; p = 0.002) and intraprocedural complications (OR: 1.89; 95%CI: 1.02-3.52; p = 0.04) as independent predictors of END. Bridging therapy (OR:2.93; 95%CI: 1.21-7.09; p = 0.017) was associated with sICH per SITS-MOST criteria whereas M1 occlusion (OR: 0.35; 95%CI: 0.18-0.69; p = 0.002), bridging therapy (OR: 2.02; 95%CI: 1.07-3.82; p = 0.03) and intraprocedural complications (OR: 5.55; 95%CI: 2.72-11.31; p < 0.001) were independently associated with sICH per ECASS II criteria. No significant association was found between the number of MT attempts and analyzed outcomes. CONCLUSIONS Regardless of the number of MT attempts and intraprocedural complications, procedural time was associated with poor outcome and END. We suggest a deeper consideration of procedural time when treating anterior circulation occlusions refractory to MT.
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Affiliation(s)
- Fabrizio Sallustio
- Ospedale dei Castelli, Rome, Italy.
- Emergency Department, Neurovascular Therapy Unit, Castels Hospital, Azienda Sanitaria Locale Roma 6, via Nettunense Km 11,500, Ariccia, 00040, Rome, Italy.
| | | | | | | | | | | | | | | | | | | | - Ilaria Casetta
- Neurology Unit, University Hospital Arcispedale S. Anna, Ferrara, Italy
| | - Enrico Fainardi
- Dipartimento di Scienze BiomedicheSperimentali e ClinicheNeuroradiologia, Università degli Studi di Firenze, Ospedale Universitario Careggi, Florence, Italy
| | - Lucio Castellan
- UO Neuroradiologia Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Nicola Limbucci
- Interventional Neurovascular Unit, Careggi University Hospital, Florence, Italy
| | | | - Mauro Bergui
- Dip Neuroscienze, Universitá di Torino, Turin, Italy
| | | | - Andrea Saletti
- Dip Neuroscienze, UO Neuroradiologia, AZOU, Ferrara, Italy
| | | | - Samuele Cioni
- UOC Neuroradiologia diagnostica e terapeutica, AOU Senese, Siena, Italy
| | | | - Luigi Simonetti
- IRCCS Istituto di Scienze Neurologiche di Bologna, UOC Neuroradiologia Ospedale Bellaria, Bologna, Italy
| | - Andrea Zini
- Department of Neurology and Stroke Center, IRCCS Istituto di Scienze Neurologiche di Bologna, Maggiore Hospital, Bologna, Italy
| | | | - Marco Longoni
- UO Neurologia e Stroke Unit Cesena-Forlì, AUSL Romagna, Cesena, Italy
| | | | | | | | | | - Stefano Vallone
- UO NeuroradiologiaOspedale Civile di Baggiovara, AOU di Modena, Modena, Italy
| | - Guido Bigliardi
- Neurologia-Stroke Unit, Ospedale Civile di Baggiovara, AOU di Modena, Modena, Italy
| | | | - Marco Petruzzellis
- UOC Neurologia e Stroke Unit "Puca" AOU Consorziale Policlinico Bari, Bari, Italy
| | - Andrea Boghi
- Neuroradiologia, Ospedale San Giovanni Bosco, Turin, Italy
| | - Andrea Naldi
- Neurology Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Alessio Comai
- Department of Neuroradiology, Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy
- Teaching Hospital of Paracelsus Medical University (PMU), Salzburg, Austria
| | - Elisa Dall'Ora
- Teaching Hospital of Paracelsus Medical University (PMU), Salzburg, Austria
- Department of Neurology, Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy
| | - Giuseppina Sanfilippo
- Radiologia e Neuroradiologia diagnostica e interventistica, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Persico
- UO Neurologia d'Urgenza e Stroke Unit, IRCCS Fondazione Mondino, Pavia, Italy
| | - Ivan Gallesio
- Department of Radiology, Neuroradiological Unit, Azienda Ospedaliera "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | - Federica Sepe
- Stroke Unit, AO "SS Antonio e Biagio e C. Arrigo", Alessandria, Italy
| | - Roberto Menozzi
- Unità Complessa di Neuroradiologia, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Alessandro Pezzini
- Dipartimento di Medicina e Chirurgia, Università degli Studi di Parma, Parma, Italy
- Programma Stroke Care, Dipartimento di Emergenza-Urgenza, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Michele Besana
- U.O NeuroradiologiaDipartimento di Neuroscienze, Presidio Ospedaliero di Cremona, ASST Cremona, Cremona, Italy
| | - Alessia Giossi
- UOC Neurologia e Stroke Unit ASST Cremona, Cremona, Italy
| | - Antioco Sanna
- SC Neuroradiologia Diagnostica e Interventistica, Pietra Ligure, Italy
| | | | - Nicola Burdi
- UOC Neuroradiologia, Ospedale "SS. Annunziata", Taranto, Italy
| | - Giovanni Boero
- UOC Neurologia, Ospedale "SS. Annunziata", Taranto, Italy
| | - Raffaele Augelli
- Neuroradiology Department, Ospedale di circolo-asst settelaghi, Varese, Italy
| | - Manuel Cappellari
- Stroke Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Nicola Giannini
- Neurological Institute, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | | | - Paolo Nunzio Nuzzi
- UO Neuroradiologia Interventistica, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Maria Carmela Spinelli
- Neurologia d'urgenza e stroke unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Annalisa Rizzo
- Department of Neurology, Vito Fazzi Hospital, Lecce, Italy
| | - Marco Filizzolo
- UO Radiologia, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Marina Mannino
- UOC Neurologia con Stroke Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Carmine Timpani
- UOC di Radiologia Diagnostica e Interventistca p.o. SS. Filippo e Nicola, Avezzano, Italy
| | - Federica De Santis
- UOC Neurologia e Stroke Unit, H SS. Filippo e Nicola, Avezzano, AQ, Italy
| | - Giuseppe Carità
- UOC Neuroradiologia, Osp.Santa Maria Misericordia, Rovigo, Italy
| | - Monia Russo
- UOS Stroke Unit-Ospedale Santa Maria Misericordia, Rovigo, Italy
| | | | | | - Salvatore Mangiafico
- Interventional Neuroradiology Consultant at IRCCS Neuromed, Pozzilli (IS), and Adjunct Professor of Interventional Neuroradiology at Tor Vergata University, Sapienza University and S. Andrea Hospital, Rome, Italy
| | - Danilo Toni
- Emergency Department Stroke Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Kara A, Soylu K, Yildirim U, Uyanik M, Coksevim M, Avci B. Comparative Analysis of Right vs. Left Radial Access in Percutaneous Coronary Intervention: Impact on Silent Cerebral Ischemia. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1193. [PMID: 39202475 PMCID: PMC11356614 DOI: 10.3390/medicina60081193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/10/2024] [Accepted: 07/22/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: Silent cerebral ischemia (SCI) is defined as a condition that can be detected by biochemical markers or cranial imaging methods but does not produce clinical symptom. This study aims both to compare the frequency of SCI in PCIs performed with right transradial access and left transradial access and to evaluate the influencing factors. Materials and Methods: A prospective, single-center study included 197 patients undergoing PCI via transradial access between November 2020 and July 2022. The patients were categorized into right radial and left radial groups. Neuron-specific enolase (NSE) values were measured and recorded before and 18 h after the procedure. A post-procedure NSE level higher than 20 ng/dL was defined as SCI. Results: SCI occurred in 60 of the 197 patients. NSE elevation was observed in 37.4% (n = 37) of the right radial group and in 23.5% (n = 23) of the left radial group (p = 0.032). Patients with SCI had higher rates of smoking (p = 0.043), presence of subclavian tortuosity (p = 0.027), and HbA1c (p = 0.031). In the multivariate logistic regression analysis, the level of EF (ejection fraction) (OR: 0.958 95% CI 0.920-0.998, p = 0.039), right radial preference (OR: 2.104 95% CI 1.102-3.995 p = 0.023), and smoking (OR: 2.088 95% CI 1.105-3.944, p = 0.023) were observed as independent variables of NSE elevation. Conclusions: Our findings suggest that PCI via right radial access poses a greater risk of SCI compared to left radial access. Anatomical considerations and technical challenges associated with right radial procedures and factors such as smoking and low ejection fraction contribute to this elevated risk.
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Affiliation(s)
- Abdulkadir Kara
- Department of Cardiology, Elbistan State Hospital, 46300 Kahramanmaraş, Turkey
| | - Korhan Soylu
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, 55270 Samsun, Turkey; (K.S.); (U.Y.); (M.C.)
| | - Ufuk Yildirim
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, 55270 Samsun, Turkey; (K.S.); (U.Y.); (M.C.)
| | - Muhammet Uyanik
- Department of Cardiology, Carsamba State Hospital, 55500 Samsun, Turkey;
| | - Metin Coksevim
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayis University, 55270 Samsun, Turkey; (K.S.); (U.Y.); (M.C.)
| | - Bahattin Avci
- Department of Biochemistry, Faculty of Medicine, Ondokuz Mayis University, 55270 Samsun, Turkey;
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Escudero-Saiz VJ, Romani NM, Rodríguez P, Morantes L, Del Risco-Zevallos J, Casals J, Xipell M, Guillén E, Piñeiro GJ, Blasco M, Rodas LM, Quintana LF, Poch E, Santana D, Molina Andújar A. Contrast-induced encephalopathy in patients with advanced chronic kidney disease: What the nephrologist needs to know. Nefrologia 2024; 44:317-322. [PMID: 38871560 DOI: 10.1016/j.nefroe.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 06/15/2024] Open
Abstract
Contrast-induced encephalopathy is a neurological complication related to contrast used in endovascular procedures or computed tomography (CT). The main risk factors are arterial hypertension, diabetes mellitus, chronic kidney disease (CKD), hyperosmolar contrasts, the amount of infused contrast and its direct infusion in the posterior cerebral territory, or pathologies with blood-brain barrier damage. Symptomatology is non-specific and may present as altered level of consciousness, neurological focality or seizures. Diagnosis is done by exclusion after ischemic or hemorrhagic stroke has been ruled out; CT or MRI are useful for differentiation. Generally, it appears shortly after exposure and the symptoms lasts 48-72h with complete recovery, although cases with persistence of symptoms or longer duration have been described. Treatment consists of monitoring, supportive measures and kidney replacement therapy (KRT) with hemodialysis (HD) in patients in chronic KRT program. It is important for the nephrologist to be aware of this entity given the susceptibility of the patient on HD as well as its potential therapeutic role in these patients.
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Affiliation(s)
| | | | - Pastora Rodríguez
- Servicio de Cardiología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Laura Morantes
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Joaquim Casals
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Marc Xipell
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Elena Guillén
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Gastón J Piñeiro
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Miguel Blasco
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Lida M Rodas
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Luis F Quintana
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Esteban Poch
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Daniel Santana
- Servicio de Neurología, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alicia Molina Andújar
- Servicio de Nefrología y Trasplante Renal, Hospital Clínic de Barcelona, Barcelona, Spain.
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Hill KA, Brinjikji W, Darin Carabenciov I. Contrast-induced encephalopathy following CT myelogram with non-ionic contrast. BMJ Case Rep 2024; 17:e259525. [PMID: 38553021 PMCID: PMC10982728 DOI: 10.1136/bcr-2023-259525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Affiliation(s)
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
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7
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Maclean MA, Rogers PS, Muradov JH, Pickett GE, Friedman A, Weeks A, Greene R, Volders D. Contrast-Induced Encephalopathy and the Blood-Brain Barrier. Can J Neurol Sci 2024:1-10. [PMID: 38453685 DOI: 10.1017/cjn.2024.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
BACKGROUND Contrast-induced encephalopathy (CIE) is an adverse event associated with diagnostic and therapeutic endovascular procedures. Decades of animal and human research support a mechanistic role for pathological blood-brain barrier dysfunction (BBBd). Here, we describe an institutional case series and review the literature supporting a mechanistic role for BBBd in CIE. METHODS A literature review was conducted by searching MEDLINE, Web of Science, Embase, CINAHL and Cochrane databases from inception to January 31, 2022. We searched our institutional neurovascular database for cases of CIE following endovascular treatment of cerebrovascular disease during a 6-month period. Informed consent was obtained in all cases. RESULTS Review of the literature revealed risk factors for BBBd and CIE, including microvascular disease, pathological neuroinflammation, severe procedural hypertension, iodinated contrast load and altered cerebral blood flow dynamics. In our institutional series, 6 of 52 (11.5%) of patients undergoing therapeutic neuroendovascular procedures developed CIE during the study period. Four patients were treated for ischemic stroke and two patients for recurrent cerebral aneurysms. Mechanical stenting or thrombectomy were utilized in all cases. CONCLUSION In this institutional case series and literature review of animal and human data, we identified numerous shared risk factors for CIE and BBBd, including microvascular disease, increased procedure length, large contrast volumes, severe intraoperative hypertension and use of mechanical devices that may induce iatrogenic endothelial injury.
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Affiliation(s)
- Mark A Maclean
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Patrick S Rogers
- Department of Diagnostic Radiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Jamil H Muradov
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Gwynedd E Pickett
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Alon Friedman
- Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Adrienne Weeks
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Ryan Greene
- Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - David Volders
- Department of Diagnostic Radiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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Ognenovski M, Pirau L, Beimer NJ, Trobe JD. Angiographic Contrast Dye-Induced Blindness and Nonconvulsive Status Epilepticus. J Neuroophthalmol 2024; 44:e197-e199. [PMID: 38366545 DOI: 10.1097/wno.0000000000001851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Affiliation(s)
- Mikhail Ognenovski
- Departments of Neurology (MO, LP, NJB, JDT), Psychiatry (NJB), and Ophthalmology and Visual Sciences (JDT), University of Michigan, Ann Arbor, Michigan
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Ren J, Ge Y, Wen R, Zhang Y, Shen J, Chen W. Contrast-induced encephalopathy after an embolization procedure for a cerebral aneurysm in a female with subarachnoid hemorrhage: a case report. BMC Neurol 2024; 24:38. [PMID: 38262944 PMCID: PMC10804565 DOI: 10.1186/s12883-024-03530-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Contrast-induced encephalopathy (CIE) is a rare complication during or after angiography, usually transient and reversible. CIE diagnosis is challenging due to the absence of no formal diagnostic criteria. CIE can mimic stroke symptoms, including visual disturbances, seizures, confusion, coma, and focal neurological deficits. This case reports neurological deficit reversal in a CIE patient due to the embolization of an intracranial aneurysm, the second angiographic procedure in six days. CASE PRESENTATION A 77-year-old woman was admitted to the hospital for headaches. The cerebral computed tomography (CT) scan indicated a subarachnoid hemorrhage. The first digital subtraction angiography (DSA) identified an aneurysm of 4 mm ∗ 3 mm in size in the M1 segment of the right middle cerebral artery (MCA). Then, embolization surgery was performed for the cerebral aneurysm, which was successful. However, the patient had post-operative headaches, slurred speech, epilepsy, limb weakness, and delirium post-procedure. The non-contrast cerebral CT indicated widespread edema in the right cerebral hemisphere. The patient was diagnosed with CIE and treated with symptomatic supportive therapy. Eventually, the patient's neurological deficits and cerebral edema improved significantly. CONCLUSIONS The current case emphasized the importance of early diagnosis and symptomatic treatment of CIE. Thus, CIE should be the first consideration during the differential diagnosis of a patient having acute neurological impairment after repeated DSA.
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Affiliation(s)
- Jing Ren
- Department of Neurology, The Second Peoples Hospital of HuiShan, Wuxi, 214000, Jiangsu, China
| | - Yinhua Ge
- Department of Neurology, The Second Peoples Hospital of HuiShan, Wuxi, 214000, Jiangsu, China
| | - Ruyi Wen
- Department of Neurology, The Second Peoples Hospital of HuiShan, Wuxi, 214000, Jiangsu, China
| | - Yong Zhang
- Department of Neurology, The Second Peoples Hospital of HuiShan, Wuxi, 214000, Jiangsu, China
| | - Jun Shen
- Department of Radiology, The Second Peoples Hospital of HuiShan, Wuxi, 214000, Jiangsu, China
| | - Wenjun Chen
- Department of Neurology, The Second Peoples Hospital of HuiShan, Wuxi, 214000, Jiangsu, China.
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10
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Kim KH, Yang K, Jeong EO, Lee HJ, Jeong H, Choi SW, Kim SH, Koh HS, Kwon HJ. Risk factor analyses of contrast leakage and contrast-induced encephalopathy following coil embolization for unruptured intracranial aneurysm. J Neurointerv Surg 2023:jnis-2023-021072. [PMID: 38129111 DOI: 10.1136/jnis-2023-021072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Contrast-induced encephalopathy (CIE) following endovascular interventions is a rare but serious complication. This study aimed to investigate the risk factors of contrast leakage (CL) and CIE in patients who underwent coil embolization of unruptured intracranial aneurysms (UIAs). METHODS Patients with UIAs who underwent coil embolization at a single tertiary institute between January 2019 and January 2022 were enrolled retrospectively. CL was defined as cortical or subcortical contrast enhancement with effacement of the cortical sulci. CIE was defined as the new onset of neurological deficits associated with CL. Following the procedure, all patients underwent CT scans, and MRI scans were performed on those with symptoms. Patient and procedural risk factors were investigated. RESULTS In total, 459 patients were analyzed. The median procedure time and contrast dose were 69 min and 96 mL, respectively. CL was evident in 35 patients. In the multivariate analysis, hypertension, large aneurysm, longer procedure time, and greater contrast dose were associated with CL. CIE was diagnosed in 19 patients, and the risk factors included large aneurysm, longer procedure time, and greater contrast dose. The procedure time was predictive of both CL (P<0.001) and CIE (P=0.01). The optimal cut-off value for procedure time was 81.5 min. All CIE patients recovered completely within 8-96 hours. CONCLUSIONS A large aneurysm and prolonged procedure time may increase the patient's risk of CL and CIE due to increased contrast exposure. Patients who underwent a procedure that exceeded 1.5 hours necessitate post-procedure evaluation and monitoring.
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Affiliation(s)
- Kyung Hwan Kim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea (the Republic of)
| | - Kiyoon Yang
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea (the Republic of)
| | - Eun-Oh Jeong
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea (the Republic of)
| | - Han-Joo Lee
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea (the Republic of)
| | - Heewon Jeong
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea (the Republic of)
| | - Seung-Won Choi
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea (the Republic of)
| | - Seon-Hwan Kim
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea (the Republic of)
| | - Hyeon-Song Koh
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea (the Republic of)
| | - Hyon-Jo Kwon
- Department of Neurosurgery, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea (the Republic of)
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11
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Uyanik M, Yildirim U, Avci B, Soylu K. Assessment of silent brain injury in patients undergoing elective percutaneous coronary intervention due to chronic total occlusion. Scand Cardiovasc J Suppl 2023; 57:25-30. [PMID: 36443919 DOI: 10.1080/14017431.2022.2150786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective: Silent brain infarcts (SBI) are thromboembolic complications associated with cardiac surgery, diagnostic angiography, and percutaneous interventions. Serum neuron-specific enolase (NSE) is the proven biomarker for measuring neuronal damage. This study aimed to evaluate the incidence of SBI, defined as elevated NSE after coronary chronic total occlusion (CTO) intervention and elective coronary stenting. Design: The study population consisted of two patient groups: the CTO group included consecutive patients with coronary CTO intervention, and the control group consisted of patients who underwent elective coronary intervention. NSE blood levels were measured before and 12-18 h after the procedure. NSE blood levels of >20 ng/mL were considered SBI. Results: A total of 108 patients were included in the study. Of these, 55 (50.9%) had SBI after the procedure. The SBI rate was 59.7% in the CTO group and 39.1% in the control group. Patients with SBI were more likely to have diabetes mellitus, hyperlipidemia, higher HbA1c, higher total stent length, and longer procedural time. Multivariate logistic regression analysis showed that CTO procedure (odds ratio [OR]: 3.129; 95% confidence interval [CI]: 1.246-7.858; p < 0.015) and diabetes mellitus (OR: 2.93; 95% CI: 1.185-7.291; p < 0.020) are independent predictors of SBI. Conclusion: Our data suggest that SBI occurs more frequently after CTO intervention than after non-CTO intervention. Intervention complexity and patient clinical characteristics may explain the increased incidence.
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Affiliation(s)
- Muhammet Uyanik
- Faculty of Medicine, Department of Cardiology, Ondokuz Mayıs University, Samsun, Turkey
| | - Ufuk Yildirim
- Faculty of Medicine, Department of Cardiology, Ondokuz Mayıs University, Samsun, Turkey
| | - Bahattin Avci
- Faculty of Medicine, Department of Biochemistry, Ondokuz Mayıs University, Samsun, Turkey
| | - Korhan Soylu
- Faculty of Medicine, Department of Cardiology, Ondokuz Mayıs University, Samsun, Turkey
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12
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Mariajoseph FP, Lai LT, Moore J, Chandra RV, Goldschlager T, Praeger A, Slater LA. Current knowledge and perspectives of contrast-induced neurotoxicity: A survey of Australian clinicians. J Clin Neurosci 2023; 116:8-12. [PMID: 37597332 DOI: 10.1016/j.jocn.2023.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Contrast-induced Neurotoxicity (CIN) is an increasingly recognised complication following endovascular procedures. It remains a relatively unexplored clinical entity, and we sought to characterise clinician perspectives towards CIN, as well as identify gaps in knowledge and provide directions for future research. METHODS An online survey was distributed to members of the Australian and New Zealand Society of Neuroradiology, as well as several Australian tertiary hospitals. Questions related to clinical exposure to CIN, diagnosis, management and pathophysiology were explored. Descriptive analysis was conducted on survey responses, and statistical analysis was performed using Chi-square and Fisher's exact test as appropriate. RESULTS A total of 95 survey responses were recorded (26.8% response rate). Only 28.4% of respondents were comfortable in diagnosing CIN, and even fewer (24.2%) were comfortable in independently managing CIN patients. Based on clinician opinion, symptoms including impaired consciousness and cortical blindness were thought to be most associated with CIN, whilst the radiological findings of parenchymal oedema and cortical enhancement were considered to be most indicative of CIN. Most clinicians agreed that further investigation is required related to pathophysiology (86.3%), diagnosis (83.2%), and treatment (82.1%). CONCLUSION CIN is a poorly understood complication following endovascular procedures. Significant gaps in clinical understanding are evident, and further investigation is vital to improve diagnosis and management.
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Affiliation(s)
- Frederick P Mariajoseph
- Department of Neurosurgery, Monash Health, Clayton, Victoria, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
| | - Leon T Lai
- Department of Neurosurgery, Monash Health, Clayton, Victoria, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Justin Moore
- Department of Neurosurgery, Monash Health, Clayton, Victoria, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Ronil V Chandra
- Monash Imaging, Monash Health, Clayton, Melbourne, Australia; Department of Radiology and Radiological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Clayton, Victoria, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Adrian Praeger
- Department of Neurosurgery, Monash Health, Clayton, Victoria, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Lee-Anne Slater
- Monash Imaging, Monash Health, Clayton, Melbourne, Australia; Department of Radiology and Radiological Sciences, Monash University, Melbourne, Victoria, Australia
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13
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Farsavian AA, Mobinikhaledi M, Ghorbani P, Ghadirzadeh E. Transient lateral rectus palsy associated with acute coronary syndrome treated with percutaneous coronary intervention: a case report. J Med Case Rep 2023; 17:389. [PMID: 37700337 PMCID: PMC10498533 DOI: 10.1186/s13256-023-04124-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Patients who experience angina and acute myocardial infarction often receive diagnostic coronary angiography and percutaneous coronary intervention. CASE PRESENTATION A 54-year-old Persian man with acute coronary syndrome was admitted to the hospital and underwent elective percutaneous coronary intervention. Two hours after the procedure, the patient experienced ophthalmoplegia and diplopia. The diagnosis was abducens nerve palsy resulting in transient lateral rectus palsy. The cause is presumed to have been an ischemic event affecting the unilateral abducens nerve. This could have occurred owing to the microembolism during the percutaneous coronary intervention, which resulted in left lateral rectus palsy. Within 1 month, the diplopia was relieved completely, and the physical examination was normal. CONCLUSION The occurrence of neuro-ophthalmic complications that may arise from percutaneous coronary intervention is extremely rare. To our knowledge, this is the second reported case of unilateral rectus palsy associated with percutaneous coronary intervention.
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Affiliation(s)
- Ali Asghar Farsavian
- Department of Cardiology, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, 4816117949, Iran
| | - Mahya Mobinikhaledi
- Department of Cardiology, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Parastoo Ghorbani
- Department of Internal Medicine, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Erfan Ghadirzadeh
- Department of Cardiology, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, 4816117949, Iran.
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14
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Dimancea A, Mattioni S, Nouet A, Drir M, Santin A, Marrot B, Shotar E, Corcy C, Bottin L, Sourour NA, Premat K, Alamowitch S, Carpentier A, Degos V, Clarençon F, Lionnet F, Lenck S. Preventive treatment of unruptured intracranial aneurysms in adult patients with sickle cell anemia: A cohort study. J Neuroradiol 2023; 50:511-517. [PMID: 36781119 DOI: 10.1016/j.neurad.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND AND PURPOSE Intracranial aneurysms are frequent in patients with sickle cell anemia, while subarachnoid hemorrhage is a major cause of death and disability in young adult patients. Several characteristics, such as younger age and smaller size at rupture, may incline therapeutic decision towards exclusion treatments. Clinical guidelines on treatment of unruptured intracranial aneurysms in this population are still missing. We aimed to assess the safety and efficacy of the treatment of unruptured intracranial aneurysm in patients with sickle cell anemia, using an adapted hematological preparation regimen. PATIENTS AND METHODS Adult patients with sickle cell anemia and treated unruptured aneurysms by endovascular therapy or neurosurgery were included in this retrospective cohort study. Treatment decision was reached after multi-disciplinary assessment. A pre-operative blood transfusion protocol was undertaken targeting a HbS below 30%. Demographic data, hematological preparation parameters and clinical and radiological outcomes were documented. RESULTS AND CONCLUSIONS Twenty-five procedures were performed in 18 patients encompassing 19 aneurysms treated by embolization and 6 by surgery. Median age at treatment was 34 years-old and median aneurysm dome size was 4.4 mm. Immediate aneurysm exclusion rate was 85.7% after endovascular therapy and 100% after neurosurgery. Median follow-up was 6 months, with all patients being asymptomatic at last follow-up. Two transitory ischemic neurological deficits, as well as four cases of iodine-induced encephalopathy were identified after embolization. No complication occurred after surgery. Endovascular therapy by coiling and neurosurgical treatment of unruptured intracranial aneurysms appears to be safe in patients with sickle cell anemia and should be considered given the specific hemorrhagic risk observed in this population. A rigorous hematological preparation, associated with a dedicated peri‑operative protocol and an adequate therapeutic strategy are essential prerequisites.
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Affiliation(s)
- A Dimancea
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - S Mattioni
- Reference Center for Sickle Cell Disease, Department of Internal Medicine, Tenon University Hospital, Paris, France
| | - A Nouet
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Paris, France
| | - M Drir
- Department of Neuro-anesthesia and Critical Care, Pitié-Salpêtrière University Hospital, Paris, France
| | - A Santin
- Reference Center for Sickle Cell Disease, Department of Internal Medicine, Tenon University Hospital, Paris, France
| | - B Marrot
- Department of Radiology, Tenon University Hospital, Paris, France
| | - E Shotar
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - C Corcy
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - L Bottin
- Department of Neurology, Pitié-Salpêtrière University Hospital, Paris, France
| | - N A Sourour
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - K Premat
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France
| | - S Alamowitch
- Department of Neurology, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France
| | - A Carpentier
- Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France
| | - V Degos
- Department of Neuro-anesthesia and Critical Care, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France
| | - F Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France; GRC BioFast. Paris VI University. Paris. France
| | - F Lionnet
- Reference Center for Sickle Cell Disease, Department of Internal Medicine, Tenon University Hospital, Paris, France
| | - S Lenck
- Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Paris, France; Paris Sorbonne University, Paris, France; Inserm UMR 1127, Paris Brain Institute, Paris, France.
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15
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Fuga M, Tanaka T, Tachi R, Yamana S, Irie K, Kajiwara I, Teshigawara A, Ishibashi T, Hasegawa Y, Murayama Y. Contrast Injection from an Intermediate Catheter Placed in an Intradural Artery is Associated with Contrast-Induced Encephalopathy following Neurointervention. AJNR Am J Neuroradiol 2023; 44:1057-1063. [PMID: 37536732 PMCID: PMC10494956 DOI: 10.3174/ajnr.a7944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/22/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND PURPOSE Contrast-induced encephalopathy can result from neurotoxicity of contrast medium in the affected area. The development of intermediate catheters has allowed guidance of catheters to more distal arteries. This study focused on the association between contrast-induced encephalopathy and contrast injection from an intermediate catheter guided into a distal intradural artery during neurointervention for cerebral aneurysms. MATERIALS AND METHODS We retrospectively reviewed 420 consecutive aneurysms in 396 patients who underwent neurointervention for extracranial aneurysms and unruptured intracranial aneurysms at our institution from February 2012 to January 2023. Patients were divided into a group with contrast-induced encephalopathy and a group without. To identify risk factors for contrast-induced encephalopathy, we compared clinical, anatomic, and procedural factors between groups by multivariate logistic regression analysis and stepwise selection. RESULTS Among the 396 patients who underwent neurointervention for cerebral aneurysms, 14 (3.5%) developed contrast-induced encephalopathy. Compared with the group without contrast-induced encephalopathy, the group with contrast-induced encephalopathy showed significantly higher rates of patients on hemodialysis, previously treated aneurysms, intradural placement of a catheter for angiography, nonionic contrast medium, and flow-diversion procedures in univariate analyses. Stepwise multivariate logistic regression analysis revealed intradural placement of a catheter for angiography (OR = 40.4; 95% CI, 8.63-189) and previously treated aneurysms (OR = 8.20; 95% CI, 2.26-29.6) as independent predictors of contrast-induced encephalopathy. CONCLUSIONS Contrast injection from an intradural artery and retreatment of recurrent aneurysms were major risk factors for contrast-induced encephalopathy. Attention should be paid to the location of the intermediate catheter for angiography to avoid developing contrast-induced encephalopathy.
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Affiliation(s)
- M Fuga
- From the Department of Neurosurgery (M.F., T.T., R.T., S.Y., A.T., Y.H.), Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - T Tanaka
- From the Department of Neurosurgery (M.F., T.T., R.T., S.Y., A.T., Y.H.), Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
- Department of Neurosurgery (T.T., S.Y., T.I., Y.M.), Jikei University School of Medicine, Tokyo, Japan
| | - R Tachi
- From the Department of Neurosurgery (M.F., T.T., R.T., S.Y., A.T., Y.H.), Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - S Yamana
- From the Department of Neurosurgery (M.F., T.T., R.T., S.Y., A.T., Y.H.), Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
- Department of Neurosurgery (T.T., S.Y., T.I., Y.M.), Jikei University School of Medicine, Tokyo, Japan
| | - K Irie
- Department of Neurosurgery (K.I.), Japanese Red Cross Medical Center, Tokyo, Japan
| | - I Kajiwara
- Department of Neurosurgery (I.K.), National Center for Global Health and Medicine, Kohnodai Hospital, Chiba, Japan
| | - A Teshigawara
- From the Department of Neurosurgery (M.F., T.T., R.T., S.Y., A.T., Y.H.), Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - T Ishibashi
- Department of Neurosurgery (T.T., S.Y., T.I., Y.M.), Jikei University School of Medicine, Tokyo, Japan
| | - Y Hasegawa
- From the Department of Neurosurgery (M.F., T.T., R.T., S.Y., A.T., Y.H.), Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
| | - Y Murayama
- Department of Neurosurgery (T.T., S.Y., T.I., Y.M.), Jikei University School of Medicine, Tokyo, Japan
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16
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Sun J, Yuan L, Yu H, Yang Y, Zhou Z, Jia D, Zhou Y, Yang S. Flow diagram of the differential diagnosis and clinical decision making in a rare case of contrast-induced encephalopathy following cardiac catheterization: a case report. BMC Cardiovasc Disord 2023; 23:280. [PMID: 37259072 DOI: 10.1186/s12872-023-03288-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 05/09/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Contrast-induced encephalopathy (CIE) is considered as an uncommon complication following cardiac catheterization. Due to the varied manifestations, CIE has no formal diagnostic criteria. In fact, the incidence of CIE may be greatly underestimated because of the difficulty in its differential diagnosis with other cerebrovascular complications. Thus, making a flow diagram according to patients' clinical symptoms and examinations after cardiac catheterization to help clinicians diagnose CIE is important and needed. CASE PRESENTATION In this report, we describe a case of probable CIE in a 66-year-old Chinese man with hypertension who underwent cardiac catheterization with stents placement in the bifurcation lesion, during which 80 ml iopromide contrast was used. About 2 h following the procedure, the patient lost his consciousness suddenly and suffered from a status epilepticus. Malignant arrhythmias were not found through continuous electrocardiogram monitoring, but mild ST-segment elevation was displayed in leads I and aVL. The echocardiography, plasma glucose and electrolyte levels were normal. Emergency re-angiography with percutaneous transluminal coronary angioplasty was performed in the culprit lesion, which involved 60 ml iopromide contrast. However, the patient remained unconsciousness and epilepticus. Non-contrast computed tomography (CT) of the head showed cortical and subarachnoid enhancement as well as prolonged retention of contrast media in the middle cerebral artery. With supportive treatment of intravenous hydration, sedative and dehydrant, the patient recovered 3 h later and finally discharged without any neurological deficits. CONCLUSIONS CIE is an acute reversible encephalopathy induced by contrast media. It is exceptionally challenging to make the diagnosis of CIE following cardiac catheterization since there is a lack of consensus on the definition of CIE. Via this case we reviewed the related literatures, through which a flow diagram of the differential diagnosis and clinical decision making was given, which could help to differentiate CIE from other neurological complications following cardiac catheterization.
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Affiliation(s)
- Jiayin Sun
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Lichuang Yuan
- Department of Cardiology, Beijing Hepingli Hospital, Beijing, China
| | - Hailiang Yu
- Department of Cardiology, Tangshan Fengrun District Second People's Hospital, Tangshan, Hebei Province, China
| | - Yanzhao Yang
- Department of Cardiology, The First Hospital of Fangshan District, Beijing, China
| | - Zhiming Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Dean Jia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Yujie Zhou
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing, China
| | - Shiwei Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Disease, The Key Laboratory of Remodeling-Related Cardiovascular Disease, Ministry of Education, Beijing, China.
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17
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Diamandis E, Swiatek VM, Behme D. Fully Reversible Contrast-Induced Encephalopathy Mimicking Stroke after Flow Diverter Treatment of Carotid Cave Aneurysm. Neurointervention 2023; 18:58-62. [PMID: 36420561 PMCID: PMC9986354 DOI: 10.5469/neuroint.2022.00353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/05/2022] [Indexed: 11/25/2022] Open
Abstract
Contrast-induced encephalopathy (CIE) is a rare complication of coronary and neurointerventional procedures. The condition is believed to arise from endothelial damage secondary to exposure to iodinated contrast media. A wide spectrum of clinical manifestations has been reported including seizures, cortical blindness, and focal neurological deficits. This report details the case of fully reversible CIE mimicking severe anterior circulation stroke in a 55-year-old female following elective endovascular treatment with a flow diverter of a carotid cave aneurysm. The patient was managed conservatively with intravenous hydration and steroids and showed an excellent prognosis with supportive management.
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Affiliation(s)
- Elie Diamandis
- Department of Neuroradiology, Otto-von-Guericke University, Magdeburg, Germany
| | - Vanessa M Swiatek
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Germany
| | - Daniel Behme
- Department of Neuroradiology, Otto-von-Guericke University, Magdeburg, Germany
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18
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Huang ST, Yu TM, Chen CH, Cheng YC, Chuang YW, Cheng CH, Liu JS, Hsu CC, Wu MJ. Risk of Major Cardiovascular Disease after Exposure to Contrast Media: A Nationwide Population-Based Cohort Study on Dialysis Patients. Metabolites 2023; 13:metabo13020266. [PMID: 36837885 PMCID: PMC9959650 DOI: 10.3390/metabo13020266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/02/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
Contrast associated kidney injury is caused by side effects of iodinated contrast media (ICM), including inflammation. Chronic inflammation among dialysis patient contributes to atherosclerosis, which leads to simultaneous conditions of the kidney, brain, and vasculature. Data to investigate the pathologic effects of ICM on cardiovascular complications in dialysis patients are lacking. Dialysis patients who had been exposed to ICM from computed tomography (ICM-CT) were allocated as the ICM-CT cohort (N = 3751), whereas dialysis patients without ICM exposure were randomly allocated as the non-ICM cohort (N = 17,196). Furthermore, 540 pairs were selected for analyses through propensity score-matching in terms of age, sex, comorbidities, dialysis vintage, and index date. During a median follow-up of 10.3 years, ICM-CT cohort had significantly higher risks in the following, compared with non-ICM cohort: all-cause mortality (adjusted hazard ratio [aHR], 1.36; 95% confidence interval [CI], 1.26-1.47), cardiovascular events (aHR,1.67; 95% CI, 1.39-2.01), acute coronary syndrome (adjusted HR: 2.92; 95% CI, 1.72-4.94), sudden cardiac arrest (aHR, 1.69; 95% CI, 0.90-3.18), heart failure (aHR, 1.71; 95% CI,1.28-2.27), and stroke (aHR, 1.84; 95% CI,1.45-2.35). The proinflammatory ICM is significantly associated with an increased risk of major cardiovascular events in patients on dialysis.
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Affiliation(s)
- Shih-Ting Huang
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung 404333, Taiwan
| | - Tung-Min Yu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung 404333, Taiwan
| | - Chia-Hsin Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Yun-Chung Cheng
- Department of Radiology, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Ya-Wen Chuang
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung 404333, Taiwan
| | - Cheng-Hsu Cheng
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- Graduate Institute of Biomedical Sciences, School of Medicine, China Medical University, Taichung 404333, Taiwan
- Department of Life Science, Tunghai University, Taichung 407224, Taiwan
| | - Jia-Sin Liu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli 35053, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli 35053, Taiwan
- Department of Health Services Administration, China Medical University, Taichung 40402, Taiwan
- National Center for Geriatrica and Welfare Research, National Health Research Institiutes, Yunlin 63247, Taiwan
- Department of Family Medicine, Min-Sheng General Hospital, Taoyuan 33044, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- RongHsing Research Center for Translational Medicine, National Chung Hsing University, Taichung 40227, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Correspondence:
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19
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Zhang Y, Zhang J, Yuan S, Shu H. Contrast-induced encephalopathy and permanent neurological deficit following cerebral angiography: A case report and review of the literature. Front Cell Neurosci 2023; 16:1070357. [PMID: 36687520 PMCID: PMC9847581 DOI: 10.3389/fncel.2022.1070357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023] Open
Abstract
Contrast-induced encephalopathy (CIE) is an uncommon complication associated with contrast exposure during angiographic procedures that is usually transient but occasionally leads to permanent complications or death. Due to the low incidence of CIE, there are still insufficient reports. This study was used to summarize the clinical features of CIE through a case report and systematic review. We summarized and reviewed 127 patients with CIE, and we found that the total incidence of CIE between men and women had no difference (49.61 and 50.39%, respectively), but the average age in female patients with CIE was older than that in male patients (62.19 and 58.77 years, respectively). Interestingly, the incidence of female patients with CIE in the poor prognosis group was significantly higher than that in the good prognosis group (62.50 and 36.51%, respectively), and the average age of these female patients in the poor prognosis group was younger than that in the good prognosis group (61.39 and 62.82 years, respectively). The contrast medium types were mainly nonionic (79.69 and 73.02%, respectively) and low-osmolar (54.69 and 71.43%, respectively) in both groups. Importantly, the total contrast media administrated in patients with poor prognoses was greater than that administrated in patients with good prognoses (198.07 and 188.60 ml, respectively). In addition, comorbidities in both groups included hypertension (55.91%), diabetes mellitus (20.47%), previous contrast history (15.75%), renal impairment (11.81%), and hyperlipidemia (3.15%). The percentage of patients with cerebral angiography was significantly higher in the poor prognosis group than that in the good prognosis group (37.50 and 9.52%, respectively), whereas the percentage of patients with coronary angiography in both groups had the opposite results (35.94 and 77.78%, respectively). In conclusion, CIE may not always have a benign outcome and can cause permanent deficits. Female gender, younger age, the higher dose of contrast medium, and the procedure of cerebral angiography may be related to the patient's poor prognosis.
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Affiliation(s)
- Yujing Zhang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiancheng Zhang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiying Yuan
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huaqing Shu
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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20
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Contrast Neurotoxicity and its Association with Symptomatic Intracranial Hemorrhage After Mechanical Thrombectomy. Clin Neuroradiol 2022; 32:961-969. [PMID: 35294573 DOI: 10.1007/s00062-022-01152-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/21/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Despite improved techniques and sophisticated postinterventional care, symptomatic intracranial hemorrhage (sICH) remains the most feared complication of mechanical thrombectomy (MT). Based on peri-interventional parameters, we aimed to discover which patients have a higher risk of sICH. METHODS From March 2017 until March 2020 consecutive patients with acute ischemic stroke (AIS) and confirmed large-vessel occlusion who underwent MT were analyzed retrospectively. Demographic, clinical, and radiological variables and parameters specific to thrombectomy were reviewed. A univariate analysis was performed and statistically significant variables were included in a logistic regression model to identify independent factors predictive of sICH. RESULTS A total of 236 patients with confirmed large-vessel occlusion were included and 22 (9.3%) had sICH. Univariate predictors of sICH included diabetes mellitus, glucose > 11.1 mmol/L, creatinine clearance (CrCl) ≤ 30 ml/min/1.73, ASPECTS indicating pretreatment infarct size, acute internal carotid artery (ICA) occlusion, stent implantation, tirofiban use, time from symptom onset to groin puncture > 4.5 h and high contrast medium consumption. In the adjusted analysis, ASPECTS < 6 (OR 3.673, p = 0.041), and amount of contrast injected ≥ 140 ml (OR 5.412, p = 0.003) were independent predictors of sICH, but not any more baseline glucose > 11.1 mmol/L (OR 1.467, p = 0.584), CrCl ≤ 30 ml/min/1.73 (OR 4.177, p = 0.069), acute ICA occlusion (OR 2.079, p = 0.181), stent implantation (OR 0.465, p = 0.512), tirofiban use (OR 5.164, p = 0.167), and time from onset-to-groin puncture (OR 1.453, p = 0.514). CONCLUSION The amount of contrast medium used is a modifiable factor associated with sICH. This association is novel and may be related to the neurotoxicity of the contrast medium disrupting the blood-brain barrier.
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Liao J, Wang Y, Shao M, Wang Y, Du J, Li X, Yang P, Fu D, Dong Z, Liu M. An unusual contrast-induced encephalopathy following percutaneous coronary intervention in patients with cerebrovascular abnormalities: A case report. Front Cardiovasc Med 2022; 9:957779. [PMID: 36505367 PMCID: PMC9729246 DOI: 10.3389/fcvm.2022.957779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Contrast-induced encephalopathy (CIE) is a complication associated with the administration of iodinated contrast, which usually happens minutes to hours after contact with contrast, and fully recovers within 72 h. The clinical manifestations of CIE are diverse, and the pathological mechanism is not explicit. Methods We report the case of a 66-year-old female who suffered from a delayed CIE following the administration of iodinated contrast agent. Symptoms were severe. Imaging examination, biochemical and etiological detection were performed timely. The course of neurological symptoms was atypical. Her complex complications of hypothyroidism and cerebrovascular abnormalities contributed to more challenges, which were also clues to the diagnosis. With prompt and active treatment, the patient recovered fully over 10 days. Discussion The diagnosis standard of CIE highly depends on the association with the contact of contrast and the exclusion of other nervous system diseases. Complicated clinical circumstances and individual specificity can lead to different clinical manifestations of CIE, making it even more difficult to diagnose and treat. Prompt and dynamic imaging examination would provide great value in the diagnosis and evaluation of CIE. Timely diagnosis and intervention may be the key to its satisfying prognosis.
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Affiliation(s)
- Jiangquan Liao
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China,*Correspondence: Jiangquan Liao,
| | - Yan Wang
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Mingjing Shao
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Yanling Wang
- Department of Cardiovascular and Respiratory Medicine, Beijing Nuclear Industry Hospital, Beijing, China
| | - Jinhang Du
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Xianlun Li
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Peng Yang
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Dongliang Fu
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Zhe Dong
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
| | - Mengru Liu
- National Integrated Traditional and Western Medicine Center for Cardiovascular Disease, China-Japan Friendship Hospital, Beijing, China
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22
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Besuden KT, Meyer-Lindenberg A, Brühschwein A. Computed tomography venography description of the normal anatomy of the canine hindlimb venous system. Anat Histol Embryol 2022; 51:459-467. [PMID: 35510896 DOI: 10.1111/ahe.12806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/17/2022] [Indexed: 12/01/2022]
Abstract
This study was performed to provide a description of the normal anatomy of the canine hindlimb veins using helical CT images. The studies of 30 dogs that underwent CT venography with a 64-slice helical CT scanner were retrospectively reviewed. The dogs were positioned in a head-first prone or head-first supine body position. A topogram CT scan was performed from the pelvic limbs cranial to the iliac wings to the tips of the paws. Bolus-tracking software was used for the dual-phase angiogram, and contrast medium was administered in a cephalic vein. The venous phase was scanned after a delay time of a few seconds after the arterial phase in a caudocranial direction. Three-dimensional images were generated using maximum intensity projections and volume rendering technique. Representative images of three of the 30 dogs were selected and anatomic structures labelled.
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Affiliation(s)
- Klara Theresia Besuden
- Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-University, Munich, Germany
| | - Andrea Meyer-Lindenberg
- Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-University, Munich, Germany
| | - Andreas Brühschwein
- Clinic for Small Animal Surgery and Reproduction, Ludwig-Maximilians-University, Munich, Germany
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23
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Kim HN, Park SY, Koh S, Kim TJ, Jung WS, Lee JS, Hong JM, Lee SJ. Contrast-induced encephalopathy and nonconvulsive status epilepticus after diagnostic cerebral angiography in an end-stage renal disease patient. PRECISION AND FUTURE MEDICINE 2022. [DOI: 10.23838/pfm.2021.00114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 70-year-old man with a history of recurrent ischemic stroke and end-stage renal disease was admitted to the neurology department for a transient ischemic attack. The patient underwent transfemoral cerebral angiography with iopamidol to evaluate the status of carotid stenosis. On the same day, the patient developed drowsy mentality, global aphasia, and fever. Electroencephalography showed continuous regional rhythmic delta activities (0.5 to 1.0 Hz) without definite spatiotemporal evolution, suggestive of focal seizure disorder arising from the left temporal area and ictal-interictal continuum. Computed tomography perfusion images showed hyperperfusion in the left hemisphere. The patient was diagnosed with contrast-induced encephalopathy and associated nonconvulsive status epilepticus. The patient was treated with oral lacosamide, levetiracetam, and daily hemodialysis. The patient’s mental status recovered after 8 days of intensive care unit care.
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Rashid H, Brown J, Nix E, Fisher Covin A. Contrast-Induced encephalopathy following diagnostic coronary angiography. Clin Case Rep 2022; 10:e05624. [PMID: 35340630 PMCID: PMC8935123 DOI: 10.1002/ccr3.5624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/15/2022] [Accepted: 03/07/2022] [Indexed: 11/08/2022] Open
Abstract
Contrast-induced encephalopathy (CIE) is a rare, reversible complication of coronary angiography that can mimic acute strokes. This case illustrates the diagnostic challenges for a patient presenting with confusion following coronary angiography and raises awareness for CIE as diagnosis of exclusion.
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Affiliation(s)
- Hytham Rashid
- University of Houston College of MedicineHoustonUSA
- HCA Houston HealthcareKingwoodUSA
- Merit Health WesleyHattiesburgUSA
| | - Jonathan Brown
- University of Houston College of MedicineHoustonUSA
- HCA Houston HealthcareKingwoodUSA
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25
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Li J, Qi G, Zhang H, Chen G, Wang S, Yan M, Sun Z. Contrast-induced encephalopathy mimicking stroke after a second cerebral DSA: an unusual case report. BMC Neurol 2021; 21:430. [PMID: 34740313 PMCID: PMC8570035 DOI: 10.1186/s12883-021-02457-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022] Open
Abstract
Background Contrast-induced encephalopathy (CIE) is a rare complication of the angiography process. CIE may mimic stroke symptoms clinically and subarachnoid hemorrhage radiologically. Previous CIE cases occurred after the initial digital subtraction angiography (DSA) scan. Here, we encountered an unusual case of CIE mimicking a stroke with an internal carotid artery (ICA) aneurysm and ipsilateral ICA stenosis that occurred after a second DSA procedure. Case presentation A 77-year-old female with a history of hypertension and coronary heart disease underwent two cerebral DSA procedures over 1 week. She was given the same nonionic and iso-osmolar Visipaque agent (smaller than 200 ml) for both procedures. However, neurological complications only occurred after the second DSA procedure. On the first diagnostic cerebral DSA, she was diagnosed with an intracranial aneurysm of the left ICA with moderate stenosis (approximately 50%) in the initial part of the ipsilateral ICA. However, after the second aneurysm embolization procedure by DSA, she developed right hemiplegia, aphasia, and epilepsy, mimicking left middle cerebral artery occlusion. An emergency CT showed a diffuse hyperdensity in the left subarachnoid space, mimicking SAH. MRI demonstrated that the lesion was hyperintense on T2WI, FLAIR imaging, and DWI but was normal on ADC mapping. On postoperative Day 6, her neurologic deficits had completely resolved after initial fluid restriction, corticosteroid treatment, and rehydration. Conclusion This case indicates that clinicians should consider the occurrence of CIE following any angiography procedure, even if the initial cerebral DSA procedure is successful and without complications.
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Affiliation(s)
- Jiaying Li
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, China
| | - Guanshu Qi
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, China.,Department of Neurology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, China
| | - Huani Zhang
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, China
| | - Gang Chen
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, China
| | - Shuting Wang
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, China.,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, China
| | - Minli Yan
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, China.,Department of Neurology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, China
| | - Zhichao Sun
- The First Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, 310053, China. .,Department of Radiology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, 310006, China.
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Murumkar V, Peer S, Jabeen S, Chauhan RS, Saini J, Aravinda RH, Lanka V, Kulkarni GB. Contrast-Induced Encephalopathy - An Unusual Complication Following Endovascular Interventions in the Anterior Circulation. Ann Indian Acad Neurol 2021; 24:635-639. [PMID: 34728981 PMCID: PMC8513941 DOI: 10.4103/aian.aian_913_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 08/30/2020] [Accepted: 09/28/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
- Vivek Murumkar
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sameer Peer
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shumyla Jabeen
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Richa S Chauhan
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ramalingaiah H Aravinda
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vivek Lanka
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish B Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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27
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Contrast Medium-Induced Encephalopathy After Coronary Angiography- Case Report. J Crit Care Med (Targu Mures) 2021; 7:145-149. [PMID: 34722917 PMCID: PMC8519365 DOI: 10.2478/jccm-2021-0010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/19/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction Contrast-induced encephalopathy represents a rare, reversible complication that appears after intravenous or intra-arterial exposure to contrast agents. There is no consensus in the literature regarding the mechanism of action. However, the theoretical mechanism is set around the disruption of the blood-brain barrier and the contrast agents’ chemical properties. Case report The case of a 70-year-old patient, known to have hypertension and type 2 diabetes mellitus is reported. The patient had undergone a diagnostic coronary angiography during which he received 100ml of Ioversol (Optiray 350™). Soon after the procedure, the patient began experiencing a throbbing headache, followed by intense behavioural changes and aggressive tendencies. He was transferred to the Neurology Clinic. The neurological examination was without focal neurological signs; however, the patient was very aggressive and uncooperative. The CT scan revealed a mild hyper-density in the frontal lobes. MRI scan revealed no pathological changes. Conservative treatment with diuretics and hydration was administered, and the patient experienced a complete resolution of symptoms in 72 hours. Conclusion Contrast-induced encephalopathy is a possible secondary complication to contrast agents and a diagnostic challenge, and it should not be overlooked, especially following procedures that use contrast agents.
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28
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Lakatos LB, Christ M, Müller M, Bolognese M. „Stroke mimics“ – Differenzialdiagnose des Schlaganfalls in der Notfallmedizin. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00877-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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29
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Liu CY, Gong N, Liu W. The Association Between Preoperative Frailty and Postoperative Delirium: A Systematic Review and Meta-analysis. J Perianesth Nurs 2021; 37:53-62.e1. [PMID: 34756625 DOI: 10.1016/j.jopan.2020.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 12/13/2020] [Accepted: 12/26/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Identifying factors that place patients at high risk for developing postoperative delirium is an important first step to reduce incidence. Frailty is associated with poor postoperative outcomes. This meta-analysis aims to determine the association between preoperative frailty and postoperative delirium. DESIGN This is a systematic review and meta-analysis. METHODS We used PubMed, Scopus, Embase, CINAHL, Cochrane, and Web of Science as databases for the search up to April 23, 2020. We included cohort studies that assessed postoperative delirium as the outcome and described the prevalence of delirium among participants during the postoperative period. Odds ratio and 95% confidence interval were calculated to examine the association. FINDINGS Twenty cohort studies met our inclusion criteria, which included a total of 4,568 patients. We found that preoperative frailty was significantly associated with an increased risk of postoperative delirium (crude odds ratio: 3.28; 95% confidence interval: 2.51 to 4.28; I2 = 46.7%) (adjusted odds ratio: 2.45; 95% confidence interval: 1.58 to 3.81; I2 = 88.6%). CONCLUSIONS This meta-analysis showed that preoperative frailty is an independent risk factor for postoperative delirium. In patients undergoing cardiovascular surgery, there is a lower association between frailty and postoperative delirium. In patients with other types of surgery, preoperative frailty is closely related to postoperative delirium.
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Affiliation(s)
- Chang-Yuan Liu
- The Second Department of Anesthesiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning, China
| | - Ning Gong
- Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Liu
- School of Nursing, Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning, China.
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30
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Matsunaga Y, Nakagawa S, Morofuji Y, Dohgu S, Watanabe D, Horie N, Izumo T, Niwa M, Walter FR, Santa-Maria AR, Deli MA, Matsuo T. MAP Kinase Pathways in Brain Endothelial Cells and Crosstalk with Pericytes and Astrocytes Mediate Contrast-Induced Blood-Brain Barrier Disruption. Pharmaceutics 2021; 13:1272. [PMID: 34452232 PMCID: PMC8400240 DOI: 10.3390/pharmaceutics13081272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/10/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022] Open
Abstract
Neurointervention with contrast media (CM) has rapidly increased, but the impact of CM extravasation and the related side effects remain controversial. This study investigated the effect of CM on blood-brain barrier (BBB) integrity. We established in vitro BBB models using primary cultures of rat BBB-related cells. To assess the effects of CM on BBB functions, we evaluated transendothelial electrical resistance, permeability, and tight junction (TJ) protein expression using immunohistochemistry (IHC) and Western blotting. To investigate the mechanism of iopamidol-induced barrier dysfunction, the role of mitogen-activated protein (MAP) kinases in brain endothelial cells was examined. We assessed the effect of conditioned medium derived from astrocytes and pericytes under iopamidol treatment. Short-term iopamidol exposure on the luminal side induced transient, while on the abluminal side caused persistent BBB dysfunction. IHC and immunoblotting revealed CM decreased the expression of TJ proteins. Iopamidol-induced barrier dysfunction was improved via the regulation of MAP kinase pathways. Conditioned medium from CM-exposed pericytes or astrocytes lacks the ability to enhance barrier function. CM may cause BBB dysfunction. MAP kinase pathways in brain endothelial cells and the interactions of astrocytes and pericytes mediate iopamidol-induced barrier dysfunction. CM extravasation may have negative effects on clinical outcomes in patients.
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Affiliation(s)
- Yuki Matsunaga
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; (Y.M.); (N.H.); (T.I.); (T.M.)
| | - Shinsuke Nakagawa
- Department of Pharmaceutical Care and Health Sciences, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan; (S.N.); (S.D.)
| | - Yoichi Morofuji
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; (Y.M.); (N.H.); (T.I.); (T.M.)
| | - Shinya Dohgu
- Department of Pharmaceutical Care and Health Sciences, Faculty of Pharmaceutical Sciences, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan; (S.N.); (S.D.)
| | - Daisuke Watanabe
- BBB Laboratory, PharmaCo-Cell Company Ltd., Dai-ichi-senshu bldg. 2nd Floor, 6-19 Chitose-machi, Nagasaki 852-8135, Japan; (D.W.); (M.N.)
| | - Nobutaka Horie
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; (Y.M.); (N.H.); (T.I.); (T.M.)
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; (Y.M.); (N.H.); (T.I.); (T.M.)
| | - Masami Niwa
- BBB Laboratory, PharmaCo-Cell Company Ltd., Dai-ichi-senshu bldg. 2nd Floor, 6-19 Chitose-machi, Nagasaki 852-8135, Japan; (D.W.); (M.N.)
| | - Fruzsina R. Walter
- Biological Barriers Research Group, Institute of Biophysics, Biological Research Centre, 6726 Szeged, Hungary; (F.R.W.); (A.R.S.-M.); (M.A.D.)
| | - Ana Raquel Santa-Maria
- Biological Barriers Research Group, Institute of Biophysics, Biological Research Centre, 6726 Szeged, Hungary; (F.R.W.); (A.R.S.-M.); (M.A.D.)
| | - Maria A. Deli
- Biological Barriers Research Group, Institute of Biophysics, Biological Research Centre, 6726 Szeged, Hungary; (F.R.W.); (A.R.S.-M.); (M.A.D.)
| | - Takayuki Matsuo
- Department of Neurosurgery, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan; (Y.M.); (N.H.); (T.I.); (T.M.)
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31
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Zhang Y, Zhou M, Wang D, Liu T, Chang P, Zhang J, Zhang R, Luo Y, Liu P. Case Report: A 62-Year-Old Woman With Contrast-Induced Encephalopathy Caused by Embolization of Intracranial Aneurysm. Front Surg 2021; 8:689713. [PMID: 34350209 PMCID: PMC8326837 DOI: 10.3389/fsurg.2021.689713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/16/2021] [Indexed: 12/22/2022] Open
Abstract
Contrast-induced encephalopathy (CIE) is a rare complication of endovascular treatment and is extensively reported as a transient and reversible phenomenon. This report describes a 62-year-old woman for embolization of an internal carotid artery (ICA) aneurysm. The operation was successful, but postoperation the patient suffered unconsciousness, blindness, hemiplegia, ophthalmoplegia, fever, and seizures. CT of the brain without the contrast showed widespread edema in the right cerebral hemisphere, which is involved in the frontal, parietal, temporal, and occipital lobes. She was diagnosed with CIE in time and treated with supportive management as soon as possible, and fortunately, the patient improved a benign course and was discharged without any neurological deficits. This study emphasizes the prevention of the CIE and the importance of early diagnosis and symptomatic treatment.
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Affiliation(s)
- Ying Zhang
- Department of Encephalopathy, Traditional Chinese Medicine Hospital of Weifang, Weifang, China
| | - Ming Zhou
- Department of Encephalopathy, Traditional Chinese Medicine Hospital of Weifang, Weifang, China
| | - Dong Wang
- Department of Encephalopathy, Traditional Chinese Medicine Hospital of Weifang, Weifang, China
| | - Tao Liu
- Department of Encephalopathy, Traditional Chinese Medicine Hospital of Weifang, Weifang, China
| | - Pengfei Chang
- Department of Encephalopathy, Traditional Chinese Medicine Hospital of Weifang, Weifang, China
| | - Jie Zhang
- Department of Encephalopathy, Traditional Chinese Medicine Hospital of Weifang, Weifang, China
| | - Rui Zhang
- Department of Encephalopathy, Traditional Chinese Medicine Hospital of Weifang, Weifang, China
| | - Yumin Luo
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Ping Liu
- Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
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Abstract
Neurological complications after cardiac surgery and percutaneous cardiac interventions are not uncommon. These include periprocedural stroke, postoperative cognitive dysfunction after cardiac surgery, contrast-induced encephalopathy after percutaneous interventions, and seizures. In this article, we review the incidence, pathophysiology, diagnosis, and management of these complications. Improved understanding of these complications could lead to their prevention, faster detection, and facilitation of diagnostic workup and appropriate treatment.
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Affiliation(s)
| | - Jeffrey Wang
- Division of Neurology, Department of Medicine, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Magdy Selim
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Qiu T, Dai X, Gong Q, Pu R, Xiao H, Shi Q, Deng X, Chen M, Guo Z. Transient oculomotor paralysis after cerebral angiography: A case report. Medicine (Baltimore) 2021; 100:e26242. [PMID: 34087911 PMCID: PMC8183771 DOI: 10.1097/md.0000000000026242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/19/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE A special case of transient oculomotor nerve palsy after cerebral angiography. PATIENT CONCERNS A 55-year-old man developed oculomotor nerve dysfunction after right radial artery puncture angiography. DIAGNOSES Cerebral angiography-induced oculomotor nerve palsy. INTERVENTIONS According to the patient's disease state, intravenous drip of dexamethasone 10 mg/d. OUTCOMES Magnetic resonance imaging (MRI) showed no abnormalities, and the patient recovered completely after 48 hours of hormone therapy. LESSONS Transient eye palsy caused by contrast agent encephalopathy is a clinically rare neurological dysfunction caused by adverse effects of contrast agents. Early prevention and correct treatment are critical.
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Affiliation(s)
| | - Xiaoyan Dai
- Equipment Management Department, Zigong First People's Hospital, Zigong, Sichuan, China
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Rowe ES, Rowe VD, Hunter J, Gralinski MR, Neves LA. A nephroprotective iodinated contrast agent with cardioprotective properties: A pilot study. J Neuroimaging 2021; 31:706-713. [PMID: 33979019 PMCID: PMC8359965 DOI: 10.1111/jon.12873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Evaluation and treatment of acute ischemic syndromes, in the heart and brain, require vessel visualization by iodinated X-ray contrast agents. However, these contrast agents can induce injury, in both the kidneys and target organs themselves. Sulfobutylether beta cyclodextrin (SBECD) added to iohexol (SBECD-iohexol) (Captisol Enabled-iohexol, Ligand Pharmaceuticals, Inc, San Diego, CA) is currently in clinical trials in cardiovascular procedures, to determine its relative renal safety in high-risk patients. Preclinical studies showed that SBECD-iohexol reduced contrast-induced acute kidney injury in rodent models by blocking apoptosis. The current study was undertaken to determine whether SBECD-iohexol is also cardioprotective, in the male rat ischemia-reperfusion model, compared to iohexol alone. METHODS After anesthesia, the left coronary artery was ligated for 30 min and the ligation released and reperfusion followed for 2 h prior to sacrifice. Groups 1-4 were injected in the tail vein 10 min prior to ischemia with: (1) vehicle; (2) iohexol; (3) SBECD; and (4) SBECD-iohexol. Infarct size, hemodynamics, and serum markers were measured. RESULTS An eight-fold increase in serum creatine kinase in the iohexol-alone group was observed, compared with no increase in the SBECD-iohexol group. The mean arterial pressure and rate pressure product were depressed in the iohexol-alone group, but not in the SBECD-iohexol group, or controls. No difference in infarct size or serum creatinine among the groups was observed. CONCLUSION The results of this study suggest that SBECD-iohexol is superior to iohexol alone, for both the preservation of cardiomyocyte integrity and preservation of myocardial function in myocardial ischemia.
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Affiliation(s)
| | | | - John Hunter
- Neurrow Pharmaceuticals, Inc, Shawnee, Kansas, USA
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Gonzalez-Pardo O, Ordoñez A, Roa C. Contrast-induced encephalopathy in an infant. Radiol Case Rep 2021; 16:1065-1067. [PMID: 33717383 PMCID: PMC7921186 DOI: 10.1016/j.radcr.2021.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 11/28/2022] Open
Abstract
Contrast-induced encephalopathy (CIE) is a well-known but rare complication following contrast media administration. Its nonspecific clinical manifestations hinder diagnosis, particularly in the pediatric population. The majority of cases are reversible, with clinical improvement and resolution of signs noted on diagnostic imaging. Here, we report the case of a 2-month-old patient with a history of complex cardiovascular disease who presented with a single episode of seizure after undergoing cardiac catheterization with nonionic iodinated contrast media. CIE is diagnosed based on the signs and symptoms exhibited by the patient and the findings on plain head computed tomography (CT) scan. Subsequently, the absence of neurological symptoms and disappearance of the imaging alterations on a control CT are documented.
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Affiliation(s)
| | - Adriana Ordoñez
- Universidad de La Sabana, Cundinamarca, Colombia. South America
| | - Carlos Roa
- Fundación Clínica Shaio, Dg 115 A #70C-75, Bogota, Colombia. South America
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Yao LD, Zhu XL, Yang RL, Zhang MM. Cardiorespiratory arrest after iso-osmolar iodinated contrast injection: A case report of contrast-induced encephalopathy following contrast-enhanced computed-tomography. Medicine (Baltimore) 2021; 100:e24035. [PMID: 33466150 PMCID: PMC7808532 DOI: 10.1097/md.0000000000024035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 12/04/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Contrast-induced encephalopathy (CIE) is a rare complication caused by administration of intravascular contrast media and characterized by acute reversible neurological disturbance. Most of the CIE cases are reported after arterial administration of contrast media such as during cerebral or coronary angiographies, yet only a few articles have reported CIE secondary to intravenous contrast. A case of CIE secondary to intravenous contrast administration is reported here. PATIENT CONCERNS A 68-year-old man was admitted to our hospital for contrast-enhanced chest computed-tomography (CT) examination due to suspected pulmonary nodules. After CT examination, the patient lost consciousness and experienced a cardiorespiratory arrest. An emergency plain brain CT was done immediately which showed abnormal cortical contrast enhancement and cerebral sulci hyperdensity. DIAGNOSES After excluding other differential diagnoses such as electrolytes imbalance, hypo/hyperglycemia, cardiogenic pathologies and other neurological emergencies such as cerebral hemorrhage, cerebral infarction, the final diagnosis of CIE was made. INTERVENTIONS The patient was admitted to the intensive care unit for further management. A series of supportive treatments were arranged. OUTCOMES Follow-up visits at the outpatient clinic showed no lasting neurological deficits. LESSONS CIE should be considered as 1 of the differential diagnoses for a patient with acute neurologic symptoms after iodinate contrast administration. Neuroradiological imaging examinations are essential to rule out other etiologies such as acute cerebral infarction or intracranial hemorrhage.
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Affiliation(s)
- Li-Ding Yao
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiu-Liang Zhu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Run-Lin Yang
- School of Medicine, University of Melbourne, Melbourne, Australia
| | - Min-Ming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Zhao Z, Huang L, Chen J, Zhu H. Rapid contrast-induced encephalopathy after a small dose of contrast agent: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2021; 1:CASE2052. [PMID: 35854690 PMCID: PMC9236172 DOI: 10.3171/case2052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/22/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Contrast-induced encephalopathy is a rare complication of cerebral angiography with only few cases reported to date. This paper reports on contrast-induced encephalopathy mimicking meningoencephalitis following cerebral angiography with iopromide, a subhypertonic nonionic contrast agent. OBSERVATIONS A 50-year-old woman underwent cerebral angiography for assessment of recurrent nasopharyngeal carcinoma with invasion of internal carotid artery. The patient experienced symptoms including a disturbance of consciousness, seizures, frequent blinking, and stiffness in the extremities immediately after angiography of the left common carotid artery using iopromide (4 ml/s, total 6 ml). Computed tomography scans of the brain showed no obvious abnormalities, whereas brain magnetic resonance imaging showed swelling of the left cerebral cortex without signs of ischemia or hemorrhage. The patient was treated with intravenous rehydration, mannitol dehydration, and other supportive treatment. With this treatment, neurological status progressively improved, with complete resolution of symptoms at day 10. LESSONS This observation highlights that even a small dose of subhypertonic nonionic contrast agent can rapidly induce contrast encephalopathy.
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Affiliation(s)
- Zhouyang Zhao
- Department of Neurosurgery, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Lijin Huang
- Department of Neurosurgery, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Jinhua Chen
- Department of Neurosurgery, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hongshen Zhu
- Department of Neurosurgery, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
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Laniyonu A, Ouyang Y, Cohen J, Awe S, Dina O, Biade S, Hargus S, Kokate T. Nonclinical Product Developmental Strategies, Safety Considerations and Toxicity Profiles of Medical Imaging and Radiopharmaceuticals Products. Mol Imaging 2021. [DOI: 10.1016/b978-0-12-816386-3.00039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Quintas-Neves M, Araújo JM, Xavier SA, Amorim JM, Cruz E Silva V, Pinho J. Contrast-induced neurotoxicity related to neurological endovascular procedures: a systematic review. Acta Neurol Belg 2020; 120:1419-1424. [PMID: 32997325 DOI: 10.1007/s13760-020-01508-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 09/19/2020] [Indexed: 10/23/2022]
Abstract
Contrast-induced neurotoxicity (CIN) is an adverse reaction to contrast agents which can occur in the context of diagnostic and therapeutic neurological endovascular procedures. Our goal was to conduct a systematic review of patients reported in the literature diagnosed with CIN after neurological endovascular procedures. A systematic search of EMBASE and MEDLINE databases was conducted. Inclusion criteria were age ≥ 18 years; neurological endovascular procedure performed ≤ 24 h before ictus; new manifestations compatible with encephalic dysfunction; imaging performed < 7 days after ictus; exclusion of other causes and manifestations attributed to pre-existing conditions. Forty-eight patients were included, of which 60.4% were female and 60.4% had arterial hypertension; median age was 63 years. The most frequent procedure was diagnostic cerebral angiography (n = 24, 50.0%) and non-ionic contrast agents were more frequently used (n = 40, 83.3%). Twenty-six patients (54.2%) developed clinical manifestations compatible with CIN during or immediately after the procedure, and the most frequent manifestations were encephalopathy, cortical blindness and motor deficit. The most frequent imaging findings were cortical contrast enhancement on CT (n = 23/42), and cortical sulci effacement (n = 18/48). Most patients presented complete clinical recovery (89.6%) at a median time of 3 days. Among patients with neuroimaging changes who underwent follow-up, complete regression of the abnormalities was shown in 81.5% at a median time of 5 days. CIN is a rare adverse reaction in the context of neurological endovascular procedures. Recognition of clinical manifestations and typical imaging abnormalities, while excluding other causes, is essential for diagnosis.
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Jiang Q, Shu L, Hong H. Application of spectral CT in the diagnosis of contrast encephalopathy following carotid artery stenting: a case report. BMC Neurol 2020; 20:413. [PMID: 33183248 PMCID: PMC7661202 DOI: 10.1186/s12883-020-01992-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 11/05/2020] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Contrast encephalopathy is a rare complication of carotid artery stenting (CAS). Contrast encephalopathy is a diagnosis of exclusion that often needs to be distinguished from high perfusion syndrome, cerebral haemorrhage, subarachnoid haemorrhage (SAH), cerebral infarction and so on. CASE PRESENTATION In this study, we report on a 70-year-old man who was admitted to the hospital with transient ischaemic attacks presenting paroxysmal weakness of limbs in the previous 2 years. He had severe stenosis of the left internal carotid artery diagnosed by digital subtraction angiography (DSA) and underwent CAS. Two hours after the operation, the patient developed paralysis of the right upper limb, unclear speech, fever and restlessness. Emergency skull computed tomography (CT) showed swelling and a linear high-density area in the left cerebral hemisphere. To clarify the components of this high-density area in the traditional CT, the patient had spectral CT, which made the diagnosis of the leakage of contrast clear. After 1 week of supportive treatment, the patient improved. CONCLUSIONS Spectral CT can easily distinguish the components of high-density areas on traditional CT, which is haemorrhage, calcification or iodine contrast leakage. Therefore, spectral CT is worth consideration for the differential diagnosis of complications of vascular intervention.
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Affiliation(s)
- Qiuhong Jiang
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Liming Shu
- Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, No. 628, Xinhun Road, Shenzhen, P. R. China
| | - Hua Hong
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou, 510080, China.
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Chu YT, Lee KP, Chen CH, Sung PS, Lin YH, Lee CW, Tsai LK, Tang SC, Jeng JS. Contrast-Induced Encephalopathy After Endovascular Thrombectomy for Acute Ischemic Stroke. Stroke 2020; 51:3756-3759. [PMID: 33121385 DOI: 10.1161/strokeaha.120.031518] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE Contrast-induced encephalopathy (CIE) is a rare and underrecognized complication after endovascular thrombectomy (EVT) for acute ischemic stroke. This study investigated the incidence and risk factors of CIE in patients who underwent EVT. METHODS Consecutive patients with acute ischemic stroke who received EVT between September 2014 and December 2019 at 2 medical centers were included. CIE was diagnosed on clinical criteria of neurological deterioration or delayed improvement within 24 hours after the procedure that was unexplained by the infarct or hemorrhagic transformation and radiological criterion of edematous change extending beyond the infarct core accompanied by contrast staining. RESULTS Of 421 patients with acute ischemic stroke who received EVT, 7 (1.7%) developed CIE. The manifestations included worsening of focal neurological signs, coma, and seizure. Patients with CIE were more likely to experience contrast-induced acute kidney injury than were those without CIE, but the volume of contrast medium was comparable between the two groups. The independent risk factors for CIE included renal dysfunction (defined as an estimated glomerular filtration rate <45 mL/min per 1.73 m2; odds ratio, 5.77 [95% CI, 1.37-24.3]; P=0.02) and history of stroke (odds ratio, 4.96 [95% CI, 1.15-21.3]; P=0.03). Patients with CIE were less likely to achieve favorable functional outcomes (odds ratio, 0.09 [95% CI, 0.01-0.87]; P=0.04). CONCLUSIONS CIE should be suspected in patients with clinical worsening after EVT accompanied by imaging evidence of contrast staining and edematous changes, especially in patients with renal dysfunction or history of stroke.
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Affiliation(s)
- Yung-Tsai Chu
- Department of Neurology (Y.-T.C., C.-H.C., L.-K.T., S.-C.T., J.-S.J.), National Taiwan University Hospital, Taipei
| | - Kang-Po Lee
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan (K.-P.L., P.-S.S.)
| | - Chih-Hao Chen
- Department of Neurology (Y.-T.C., C.-H.C., L.-K.T., S.-C.T., J.-S.J.), National Taiwan University Hospital, Taipei
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan (K.-P.L., P.-S.S.)
| | - Yen-Heng Lin
- Department of Medical Imaging (Y.-H.L., C.-W.L.), National Taiwan University Hospital, Taipei
| | - Chung-Wei Lee
- Department of Medical Imaging (Y.-H.L., C.-W.L.), National Taiwan University Hospital, Taipei
| | - Li-Kai Tsai
- Department of Neurology (Y.-T.C., C.-H.C., L.-K.T., S.-C.T., J.-S.J.), National Taiwan University Hospital, Taipei
| | - Sung-Chun Tang
- Department of Neurology (Y.-T.C., C.-H.C., L.-K.T., S.-C.T., J.-S.J.), National Taiwan University Hospital, Taipei
| | - Jiann-Shing Jeng
- Department of Neurology (Y.-T.C., C.-H.C., L.-K.T., S.-C.T., J.-S.J.), National Taiwan University Hospital, Taipei
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Zevallos CB, Dai B, Dandapat S, Quispe-Orozco D, Holcombe A, Ansari S, Farooqui M, Derdeyn CP, Samaniego EA, Ortega-Gutierrez S. Greater intraprocedural systolic blood pressure and blood pressure variability are associated with contrast-induced neurotoxicity after neurointerventional procedures. J Neurol Sci 2020; 420:117209. [PMID: 33187680 DOI: 10.1016/j.jns.2020.117209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Contrast-induced neurotoxicity (CIN) is a rare complication of neurointerventional procedures and its understanding remains limited. We evaluated the association of CIN with systemic hemodynamics in patients undergoing neuroendovascular interventions. METHODS We conducted a 1:2 matched case-control study from a prospectively collected database of 2510 neurointerventional patients. We defined CIN as new neurological deficits presented ≤24 h post-operation after excluding other possible etiologies. We obtained demographic, clinical and imaging data, and baseline and intraprocedural blood pressures (BP) from medical records. The area between baseline and intraprocedural BP was used to measure sustained variability of BP over time. A generalized linear mixed model and generalized estimating equation were used to analyze the BP difference between groups over time. RESULTS We evaluated 11 CIN cases and 22 controls. 2746 and 5837 min of continued BP data were analyzed for cases and controls, respectively. CIN cases had higher measurements and greater variability for: Systolic BP (SBP) [median 125 (IQR:121-147) vs. 114 (IQR:107-124) mmHg], median area above baseline [median 350 (IQR:25-1328) vs. 52 (IQR:0-293) mmHg*minutes] and mean arterial pressure (MAP) [median 85 (IQR:79-98) vs. 80 (IQR:74-89) mmHg]. CIN cases demonstrated a significant mean increase in SBP and MAP of 23.41 mmHg (p < 0.01) and 13.79 mmHg (p < 0.01) when compared to controls, respectively, over the perioperative time. CONCLUSION Sustained hypertension and high BP variability may contribute to the pathophysiology of CIN. Acute hypertension can increase blood-brain barrier permeability and potentially allow contrast to leak into the brain parenchyma causing direct toxicity and CIN symptoms.
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Affiliation(s)
- Cynthia B Zevallos
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Biyue Dai
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Sudeepta Dandapat
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Darko Quispe-Orozco
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Andrea Holcombe
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Sameer Ansari
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Mudassir Farooqui
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Colin P Derdeyn
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Edgar A Samaniego
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Santiago Ortega-Gutierrez
- Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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Vigano' M, Mantero V, Basilico P, Cordano C, Sangalli D, Reganati P, Lunghi A, Rigamonti A, Salmaggi A. Contrast-induced encephalopathy mimicking total anterior circulation stroke: a case report and review of the literature. Neurol Sci 2020; 42:1145-1150. [PMID: 33089478 DOI: 10.1007/s10072-020-04844-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Contrast-induced encephalopathy is a rare and usually reversible entity due to the administration of iodinated contrast. Clinical manifestations include cortical blindness, encephalopathy, seizures and focal neurological deficits. METHODS We report the case of a 56-year-old woman who developed global aphasia and right hemiplegia after a cerebral angiography performed for a subarachnoid haemorrhage. A prompt brain MRI resulted negative, while CT scan revealed left cerebral oedema with the cerebral sulci effacement. Complete recovery was observed in 10 days. DISCUSSION Diagnosis of contrast-induced encephalopathy requires a temporal correlation between neurological dysfunction and administration of iodinated contrast. Usually, the symptomatology is transient with a full recovery within 48-72 h. The most common symptom is cortical blindness, while other symptoms have been rarely reported. Only 20 cases previously reported global aphasia and/or hemiplegia or mimed anterior circulation strokes. Prompt brain neuroimaging is essential in order to exclude an alternative diagnosis that requires a distinct therapeutic approach.
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Affiliation(s)
- Martina Vigano'
- Neurological Department, "A. Manzoni" Hospital, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Vittorio Mantero
- Neurological Department, "A. Manzoni" Hospital, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy.
| | - Paola Basilico
- Neurological Department, "A. Manzoni" Hospital, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Christian Cordano
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Davide Sangalli
- Neurological Department, "A. Manzoni" Hospital, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Paolo Reganati
- Neuroradiological Unit, "A. Manzoni" Hospital, ASST Lecco, Lecco, Italy
| | - Alessandro Lunghi
- Neuroradiological Unit, "A. Manzoni" Hospital, ASST Lecco, Lecco, Italy
| | - Andrea Rigamonti
- Neurological Department, "A. Manzoni" Hospital, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Andrea Salmaggi
- Neurological Department, "A. Manzoni" Hospital, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
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Zevallos CB, Dandapat S, Ansari S, Farooqui M, Quispe-Orozco D, Mendez-Ruiz A, Derdeyn C, Hasan D, Samaniego EA, Ortega-Gutierrez S. Clinical and Imaging Features of Contrast-Induced Neurotoxicity After Neurointerventional Surgery. World Neurosurg 2020; 142:e316-e324. [DOI: 10.1016/j.wneu.2020.06.218] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/25/2020] [Accepted: 06/28/2020] [Indexed: 11/25/2022]
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Silent cerebral infarction after percutaneous coronary intervention of chronic total occlusions (CTO) and non-CTOs. Int J Cardiovasc Imaging 2020; 36:2107-2113. [PMID: 32681317 DOI: 10.1007/s10554-020-01939-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
Silent cerebral infarctions (SCI) determined by neuron specific enolase (NSE) elevation may develop more during chronic total occlusion (CTO) percutaneous coronary interventions (PCI) than non-CTO interventions. Our aim was to examine CTO and non-CTO PCIs for SCI development. 100 consecutive CTO and 100 non-CTO PCI patients were enrolled. SCI was detected by serum NSE measurements performed at baseline and 12 h after the interventions. New NSE elevations > 12 ng/mL after the procedure were counted as SCI. Post-procedural NSE levels were found to be significantly higher in the CTO PCI group and NSE positivity was more prevalent in the CTO PCI group (56 (56%) vs. 31 (31%), p < 0.001), but PCI of CTOs did not independently increase risk of SCI (OR: 2.39 (0.85-6.73), p: 0.10). Patients who developed SCI after PCI had the characteristics of tough PCI interventions. In the multivariate analysis, two parameters were found to be independently associated with SCI development, namely more contrast volume (OR: 1.014 (1.005-1.023), p: 0.003) and longer procedural time (OR: 1.030 (1.010-1.051), p: 0.003). It has been firstly demonstrated in the literature that CTO PCIs, by its nature, have increased rates of SCI when compared to non-CTO PCIs but presence of a CTO was not an independent predictor of SCI. Mainly, procedural characteristics of the PCIs, especially longer procedural times and more contrast consumption, observed more in CTO PCIs, have been found to be independently associated with elevations of plasma NSE levels.
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Yan WT, Li XZ, Yan CX, Liu JC. Typical subdural contrast effusion secondary to endovascular treatment of a pediatric pial arteriovenous fistula. Interv Neuroradiol 2020; 27:31-36. [PMID: 32611214 DOI: 10.1177/1591019920938965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Subdural contrast effusion secondary to endovascular treatment is exceptionally rare and might be mistaken as subdural hematoma because of similar hyperattenuation on computer tomography. The authors present the case of a 13-month-old girl with a history of increased head circumference and developmental retardation. Cerebral digital subtraction angiography showed a high-flow pial arteriovenous fistula fed by multiple arteries on the right cerebellar surface, with occlusion of the right sigmoid sinus and severe stenosis of the left sigmoid sinus. Staged endovascular treatments were performed to eliminate the fistula. Follow-up head computer tomography scans performed 3 h after both procedures demonstrated typical high-density subdural effusion with computer tomography attenuation value similar to hemorrhage. These effusions did not aggravate the condition and disappeared spontaneously 32 h after the first treatment and 29 h after the second, respectively.
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Affiliation(s)
- Wen-Tao Yan
- Department of Neurosurgery, 455994Capital Medical University Sanbo Brain Hospital, Beijing, China
| | - Xiu-Zhen Li
- Department of Neurosurgery, 455994Capital Medical University Sanbo Brain Hospital, Beijing, China
| | - Chang-Xiang Yan
- Department of Neurosurgery, 455994Capital Medical University Sanbo Brain Hospital, Beijing, China
| | - Jia-Chun Liu
- Department of Neurosurgery, 455994Capital Medical University Sanbo Brain Hospital, Beijing, China
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Harada Y, Kairamkonda SR, Ilyas U, Pothineni NVK, Samant RS, Shah VA, Kapoor N, Onteddu S, Nalleballe K. Pearls & Oy-sters: Contrast-induced encephalopathy following coronary angiography: A rare stroke mimic. Neurology 2020; 94:e2491-e2494. [PMID: 32381554 DOI: 10.1212/wnl.0000000000009590] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Yohei Harada
- From the Departments of Neurology (Y.H., S.R.K., U.I., V.A.S., N.K., S.O., K.N.), Cardiology (N.V.K.P.), and Radiology (R.S.S.), University of Arkansas for Medical Sciences, Little Rock.
| | - Supriya R Kairamkonda
- From the Departments of Neurology (Y.H., S.R.K., U.I., V.A.S., N.K., S.O., K.N.), Cardiology (N.V.K.P.), and Radiology (R.S.S.), University of Arkansas for Medical Sciences, Little Rock
| | - Ushna Ilyas
- From the Departments of Neurology (Y.H., S.R.K., U.I., V.A.S., N.K., S.O., K.N.), Cardiology (N.V.K.P.), and Radiology (R.S.S.), University of Arkansas for Medical Sciences, Little Rock
| | - Naga V K Pothineni
- From the Departments of Neurology (Y.H., S.R.K., U.I., V.A.S., N.K., S.O., K.N.), Cardiology (N.V.K.P.), and Radiology (R.S.S.), University of Arkansas for Medical Sciences, Little Rock
| | - Rohan S Samant
- From the Departments of Neurology (Y.H., S.R.K., U.I., V.A.S., N.K., S.O., K.N.), Cardiology (N.V.K.P.), and Radiology (R.S.S.), University of Arkansas for Medical Sciences, Little Rock
| | - Vishank A Shah
- From the Departments of Neurology (Y.H., S.R.K., U.I., V.A.S., N.K., S.O., K.N.), Cardiology (N.V.K.P.), and Radiology (R.S.S.), University of Arkansas for Medical Sciences, Little Rock
| | - Nidhi Kapoor
- From the Departments of Neurology (Y.H., S.R.K., U.I., V.A.S., N.K., S.O., K.N.), Cardiology (N.V.K.P.), and Radiology (R.S.S.), University of Arkansas for Medical Sciences, Little Rock
| | - Sanjeeva Onteddu
- From the Departments of Neurology (Y.H., S.R.K., U.I., V.A.S., N.K., S.O., K.N.), Cardiology (N.V.K.P.), and Radiology (R.S.S.), University of Arkansas for Medical Sciences, Little Rock
| | - Krishna Nalleballe
- From the Departments of Neurology (Y.H., S.R.K., U.I., V.A.S., N.K., S.O., K.N.), Cardiology (N.V.K.P.), and Radiology (R.S.S.), University of Arkansas for Medical Sciences, Little Rock
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Transient contrast-induced encephalopathy after internal carotid artery embolisation prior to surgery for nasopharyngeal carcinoma. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2018.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ma JR, Fan MM, Wang ZS. Age, preoperative higher serum cortisol levels, and lower serum acetylcholine levels predict delirium after percutaneous coronary intervention in acute coronary syndrome patients accompanied with renal dysfunction. Indian J Psychiatry 2020; 62:172-177. [PMID: 32382177 PMCID: PMC7197847 DOI: 10.4103/psychiatry.indianjpsychiatry_37_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/06/2019] [Accepted: 12/24/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The objective of the study is to investigate the incidence and risk factors of delirium after percutaneous coronary intervention (PCI) in acute coronary syndrome (ACS) patients accompanied with renal dysfunction. MATERIALS AND METHODS This was a prospective and cohort study, performed in a medical center from July 2014 to June 2017, which enrolled ACS patients accompanied with renal dysfunction who were treated with PCI. Univariate analysis and binary logistic regression analysis was used to determine the incidence and risk factors of delirium. RESULTS Data were analyzed from 119 patients. The 7-day incidence of delirium after PCI in ACS patients accompanied with renal dysfunction was 15.97% (n = 19/119). The binary logistic regression analysis results indicate that age (odd ratio [OR] 1.463; 95% confidence interval [CI] 1.070-2.001; P = 0.017), preoperative higher serum cortisol (COR) (OR 1.025; 95% CI 1.002-1.048; P = 0.030), and lower serum acetylcholine (Ach) (OR 0.965; 95% CI 0.937-0.993; P = 0.016) were significant differences in delirium and nondelirium groups. CONCLUSIONS Age, preoperative higher serum COR levels, and lower serum Ach levels were independent risk factors for delirium after PCI in ACS patients accompanied with renal dysfunction.
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Affiliation(s)
- Jing Ru Ma
- Department of Cardiology, Second Affiliated Hospital of Shenyang Medical College, Shenyang, China
| | - Meng Meng Fan
- Department of Cardiology, Second Affiliated Hospital of Shenyang Medical College, Shenyang, China
| | - Zhan Sheng Wang
- Department of Cardiology, Fourth People's Hospital of Shenyang, Shenyang, China
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Recurrent epileptic seizures following cardiac catheterization with iodixanol: a case report. BMC Cardiovasc Disord 2020; 20:79. [PMID: 32054458 PMCID: PMC7017615 DOI: 10.1186/s12872-020-01341-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 01/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Contrast-induced encephalopathy (CIE) is a rare complication of cardiac catheterization; clinical manifestations include cortical blindness, seizures and focal neurological deficits. In general, recurrent epileptic seizures following cardiac catheterization with iodixanol occur more rarely than do other complications. CASE PRESENTATION Here, we report a case of a 76-year-old male patient who experienced unstable angina for nearly 10 months and was admitted to our hospital. Repeat cardiac catheterization was performed using iodixanol. At approximately 20 h after the first cardiac catheterization, his upper limbs began to exhibit slight trembling; the patient was conscious and could not control these movements. A total of 6 episodes occurred before the second cardiac catheterization was performed, with each episode lasting approximately 2 s. These symptoms were not treated. At approximately 2 h after the second cardiac catheterization, the symptoms became more severe, and the frequency of the episodes increased significantly; the symptoms had fully subsided at 6 h after the second operation. An electroencephalogram (EEG) demonstrated diffuse slowing with epileptiform abnormalities. Paroxysmal spike-wave and slow wave discharges were observed in the bilateral areas, and the abnormalities were marked in the frontal areas. These observations led us to conclude that the patient was experiencing epileptic seizures. During 6 months of monthly clinical follow-up visits after discharge, no abnormalities of the nervous system were found by cardiologists or neurologists, and the patient's EEG was normal. No antiepileptic drugs were administered throughout this process. CONCLUSIONS CIE, especially recurrent epileptic seizures, is a rare but often reversible complication of cardiac catheterization with iodixanol. Its symptoms can be mild and therefore are easily ignored by physicians. Early CIE detection may be achieved by EEG. Repeated exposure to contrast agents carries the risk of recurrent epileptic seizures.
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