1
|
Mariajoseph FP, Yu D, Lai LT, Moore J, Goldschlager T, Chandra RV, Praeger A, Slater LA. Neuroradiological features of contrast-induced neurotoxicity: A systematic review and pooled analysis. J Clin Neurosci 2024; 126:108-116. [PMID: 38870639 DOI: 10.1016/j.jocn.2024.05.038] [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: 04/19/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Contrast-induced neurotoxicity (CIN), is an increasingly recognised complication of endovascular procedures, presenting as a spectrum of neurological symptoms that mimic ischaemic stroke. The diagnosis of CIN remains a clinical challenge, and stereotypical imaging findings are not established. This study was conducted to characterise the neuroimaging findings in patients with CIN, to raise diagnostic awareness and improve decision making. METHODS We performed a systematic review of PubMed and Embase databases from inception (1946/1947) to June 2023 for reports of CIN following administration of iodinated contrast media. Studies with a final diagnosis of CIN, which provided details of neuroimaging were included. All included cases were pooled and descriptive analysis was conducted. RESULTS A total of 84 patients were included, with a median age of 64 years. A large proportion of patients had normal imaging (CT 40.8 %, MRI 53.1 %). CT abnormalities included cortical/subarachnoid hyperattenuation (42.1 %), cerebral oedema/sulcal effacement (26.3 %), and loss of grey-white differentiation (7.9 %). Frequently reported MRI abnormalities included brain parenchymal MRI signal change (40.8 %) and cerebral oedema (12.2 %), most commonly observed on FLAIR sequences (26.5 %). Characterisation of imaging findings according to anatomical location and clinical symptoms has been conducted. CONCLUSIONS Neuroimaging is an essential part of the diagnostic workup of CIN. Analysis of the anatomical location and laterality of imaging abnormalities may suggest relationship between radiological features and actual clinical symptoms, although this remains to be confirmed with dedicated study. Radiological abnormalities, particularly CT, appear to be transient and reversible in most patients.
Collapse
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.
| | - Daniel Yu
- 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
| | - 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
| | - Ronil V Chandra
- Monash Imaging, Monash Health, Clayton, Melbourne, Australia; Department of Radiology, 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, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Damavandi PT, Calì D, Negro G, Girombelli A, Lattanzi S. Contrast Medium-Induced Transient Cortical Blindness: A Systematic Review of the Literature. J Vasc Interv Radiol 2024:S1051-0443(24)00400-7. [PMID: 38906244 DOI: 10.1016/j.jvir.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/25/2024] [Accepted: 06/09/2024] [Indexed: 06/23/2024] Open
Abstract
PURPOSE To summarize identified risk factors, the most common clinical presentations, radiological and neurophysiological features, and proposed pathophysiological mechanisms of contrast medium-induced transient cortical blindness (TCB). METHODS A systematic search of PubMed, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov was performed. A total of 115 patients from 2 retrospective cohort studies, 10 case series, and 52 case reports were included. RESULTS The available evidence suggests that TCB can manifest after both invasive and noninvasive contrast-enhanced procedures. The pathophysiology of TCB is unclear; however, the primary mechanism suggested involves the direct neurotoxic effect of the contrast medium. Ionic, nonionic, hyperosmolar, isoosmolar, and even ethiodized oil have been implicated. Imaging findings are nonspecific, and absent in about half of patients. Onset is within 30 minutes in about half of patients and resolves within 1 day in about half of patients, but delayed onset after a day and delayed resolution after a week may occur. Higher contrast medium dosage and its injection solely into the posterior circulation were the only risk factors identified in association with TCB. CONCLUSIONS TCB is a rare, idiopathic, and typically self-limited condition associated with direct posterior cerebral neurotoxicity of iodinated contrast media, and appears to be dose-dependent.
Collapse
Affiliation(s)
| | - Davide Calì
- Independent Researcher, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giulia Negro
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, School of Medicine and Surgery, Milan Center for Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Alessandro Girombelli
- Division of Anesthesiology, Department of Anesthesiology, Intensive Care and Emergency Medicine, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| |
Collapse
|
3
|
Nakao K, Joshi G, Hirose Y, Tanaka R, Yamada Y, Miyatini K, Thavara BD, Kawase T, Kato Y. Rare Cases of Contrast-Induced Encephalopathies. Asian J Neurosurg 2020; 15:786-793. [PMID: 33145256 PMCID: PMC7591187 DOI: 10.4103/ajns.ajns_68_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/09/2020] [Accepted: 04/29/2020] [Indexed: 11/18/2022] Open
Abstract
Cortical blindness (CB) due to contrast-induced encephalopathy is a rare complication in endovascular procedure. Although exact mechanism is not known, disruption of blood–brain barrier (BBB) by contrast agent is supposed to be caused. We report two cases of contrast-induced encephalopathies after coil embolization of unruptured aneurysm. A 68-year-old woman with unruptured basilar artery aneurysm was treated with endovascular stent-assisted coil embolization. The procedure was successfully accomplished within 172 min using about 160 ml of contrast medium (iopamidol). However, she manifested with CB 3 h after the procedure and seizure on the next day. Immediate computed tomography revealed the cortical enhancement in both occipital lobes. Diffusion-weighted imaging–magnetic resonance imaging and fluid-attenuated inversion recovery sequence 1 day after the procedure revealed edema in both occipital lobes with no findings of ischemia or hyperperfusion. Electroencephalography showed sharp and slow waves in both occipital lobes. She required endotracheal intubation on day 2 to maintain airways and breathing. Her sensorium improved 4 days after the procedure with administration of steroid and anticonvulsant. She was extubated on day 4 after the procedure. She was discharged with persisting CB as a sequel.
Collapse
Affiliation(s)
- Kazutaka Nakao
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Girish Joshi
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan.,Department of Neurosurgery, Apollo Speciality Hospital, Bengaluru, Karnataka, India
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan.,Department of Neurosurgery, Fujita Health University, Nagoya, Aichi, Japan
| | - Riki Tanaka
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Yasuhiro Yamada
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Kyosuke Miyatini
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Binoy Damodar Thavara
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan.,Department of Neurosurgery, Government Medical College, Thrissur, Kerala, India
| | - Tsukasa Kawase
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
| |
Collapse
|
4
|
Renault P, Rouchet S. Transient global amnesia and transient cortical blindness secondary to contrast induced encephalopathy after renal artery angiography. Rev Neurol (Paris) 2019; 175:335-336. [DOI: 10.1016/j.neurol.2018.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/02/2018] [Accepted: 08/26/2018] [Indexed: 10/27/2022]
|
5
|
Naito H, Yamazaki Y, Takahashi T, Ochi K, Kiura Y, Matsumoto M. [A case of posterior reversible encephalopathy syndrome associated with coil embolization of a basilar apex aneurysm]. Rinsho Shinkeigaku 2013; 53:518-25. [PMID: 23892962 DOI: 10.5692/clinicalneurol.53.518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
About three weeks after successful coil embolization of a basilar apex aneurysm, a 66-year-old woman developed occipital headaches. T2 and FLAIR MRI brain images demonstrated multiple new hyperintense lesions in the posterior circulation territory including cerebellum, right superior cerebellar peduncle, left thalamus and bilateral temporo-occipital lobes and she was subsequently hospitalized. Findings suggestive of other underlying disease were not observed, although an increased protein level was noted in cerebrospinal fluid (69 mg/dl). Headache and clinical findings improved approximately 12 weeks after coil embolization. MRI findings also showed improvement. These clinical and radiological findings made this patient a distinctive case of posterior reversible encephalopathy syndrome (PRES) associated with coil embolization suggesting that clinicians should be aware that PRES can present as comparatively mild symptoms several weeks after coil embolization.
Collapse
|