Contrast-induced encephalopathy: a complication of coronary angiography

Contrast-induced encephalopathy with significantly elevated levels of cerebrospinal fluid protein

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.

The varied clinical and radiological manifestations of contrast-induced encephalopathy following coronary angiography

Contrast-induced encephalopathy (CIE) is a rare complication of imaging using ionidated contrast media. Its pathogenesis remains unknown, and its clinical presentation is variable. We present two cases of CIE following coronary angiography (CAG) that underscore the multitude of clinical manifestations and imaging findings associated with the disorder. In patient 1, CIE manifested during the CAG with agitation and decreased consciousness, followed by left hemiparesis and visual neglect. Native computed tomography (CT) of the head was unremarkable but CT perfusion (CTP) showed extensive hypoperfusion of the right hemisphere with corresponding slow-wave activity in the electroencephalogram (EEG). These findings were more pronounced the next day. Magnetic Resonance Imaging (MRI) revealed multiple small dot-like ischemic lesions across the brain. By day 6, she had fully recovered. Patient 2 developed transient expressive aphasia during the CAG followed by migraineous symptoms. Native head CT showed a large area of parenchymal edema, sulcal effacement and variable subarachnoid hyperdensity in the right hemisphere. He developed mild left-side hemiparesis, spontaneous gaze deviation and inattention. Brain MRI showed small dot-like acute ischemic lesions across the brain. The next morning, he had a generalized tonic-clonic seizure (GTCS) after which native head CT was normal, but the EEG showed a post-ictal finding covering the right hemisphere. His hemiparesis resolved within 2 months. The diversity in clinical and radiographic presentations suggest that CIE involve many pathophysiological processes.

Contrast-Induced Encephalopathy after Endovascular Treatment: Two Case Reports

Contrast-induced encephalopathy (CIE) is a rare neurological complication that occurs after the use of contrast medium in various angiographic procedures. Symptoms can be different, from headache to severe neurological deficit and coma. In the articles published to date, symptoms appeared immediately after application of contrast agent or within 24 hours. Here we present two cases of patients in whom CIE developed delayed after endovascular treatment.

Flow diagram of the differential diagnosis and clinical decision making in a rare case of contrast-induced encephalopathy following cardiac catheterization: a case report

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.

Contrast-induced encephalopathy following endovascular treatment for intracranial aneurysms-risk factors analysis and clinical strategy

PURPOSE

Contrast-induced encephalopathy (CIE) was defined as new onset of neurological deficits after exposure to contrast media, which could be observed after the endovascular treatment for intracranial aneurysms.

METHODS

We enrolled a consecutive cohort of patients who underwent endovascular treatment for unruptured intracranial aneurysms. CIE was defined as a reversible neuropathic syndrome that occurred after interventional therapy, accompanied by imaging abnormalities and excluding other diseases. Multivariable Poisson regression analysis was performed to show risk factors by incidence rate ratio (IRR) and a clinical strategy was proposed.

RESULTS

Among the 579 patients who underwent interventional therapy for intracranial aneurysms, the crude incidence rate of CIE was 2.4% (95% CI, 1.2-3.6%) at our center. Headache, hemiplegia, and disorientation could be initial symptoms, and cortical blindness was the most common localized deficit. Cerebral edema and sulci effacement on CT were observed, and re-revaluation after treatments on CT/MRI showed absent lesions. The risk factors were history of stroke (IRR, 7.752; P = 0.007), history of hypertension (IRR, 1.064; P = 0.042), posterior circulation aneurysms (IRR, 9.412; P = 0.004) and higher dosage of contrast agents (IRR, 1.018; P = 0.007). After the strategy of accelerating excretion of contrast agents, reduction of intracranial pressure and anti-inflammation/vasospasm therapy, the prognosis was favorable with most patients fully recovered within 72 h.

CONCLUSION

History of stroke and posterior circulation aneurysms were main risk factors for CIE. A higher dosage of contrast agents might induce CIE, and the history of hypertension should be considered as well.

Contrast-induced encephalopathy and permanent neurological deficit following cerebral angiography: A case report and review of the literature

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.

An unusual contrast-induced encephalopathy following percutaneous coronary intervention in patients with cerebrovascular abnormalities: A case report

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.