1
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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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2
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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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3
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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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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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5
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Otsubo H, Yoshie T, Araga T, Tatsuno K, Takaishi S, Usuki N, Yoshida Y, Ono H, Ueda T. A Case Report of Contrast-Induced Encephalopathy after Repeated Percutaneous Transluminal Angioplasty for Acute Middle Cerebral Artery Occlusion. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:371-375. [PMID: 37502340 PMCID: PMC10370915 DOI: 10.5797/jnet.cr.2021-0061] [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: 03/31/2021] [Accepted: 09/12/2021] [Indexed: 07/29/2023]
Abstract
Objective We report a case of contrast-induced encephalopathy (CIE) after repeated percutaneous transluminal angioplasty (PTA) for acute middle cerebral artery (MCA) occlusion. Case Presentation An 88-year-old woman with left hemiparesis was transferred to our hospital by ambulance. MRI revealed acute MCA M1 occlusion. We performed intravenous tissue plasminogen activator therapy and PTA for right MCA occlusion, leading to complete recanalization and improvement in hemiparalysis. After approximately one week, restenosis of right MCA developed and PTA was performed again on day 11. However, her left hemiparesis exacerbated shortly thereafter. CT demonstrated leakage of contrast medium, and an extensive high-intensity area (HIA) on the white matter in the right cerebral hemisphere was noted on MRI FLAIR. The HIA on MRI and neurological deficits gradually improved after conservative treatment, but diffuse atrophy of the right cerebral hemisphere occurred and higher brain dysfunction remained. Conclusion Repeated ischemia and reperfusion, and the frequent use of contrast media were considered the causes of CIE.
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Affiliation(s)
- Haruki Otsubo
- Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Tomohide Yoshie
- Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Takashi Araga
- Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Kentaro Tatsuno
- Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Satoshi Takaishi
- Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Noriko Usuki
- Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Yasuyuki Yoshida
- Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Hajime Ono
- Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
| | - Toshihiro Ueda
- Stroke Center, St. Marianna University Toyoko Hospital, Kawasaki, Kanagawa, Japan
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6
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Jia-hao Z, Richard SA, Yin-sheng D, Ming J, Yan Z. Contrast-enhanced encephalopathy and massive cerebral edema after endovascular coiling of cerebral aneurysm. A case report. VEINS AND LYMPHATICS 2021. [DOI: 10.4081/vl.2021.9767] [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
Contrast-induced encephalopathy (CIEP) is a rare complication after endovascular therapy. The etiology of CIEP is still a matter of debate. We present a rare occurrence of CIEP in a known hypertensive and type 2 diabetic patient after endovascular coiling of cerebral aneurysm with oculomotor nerve palsy. A 68-year old female presented with seven days history of headache and left ptosis or blepharoptosis with mild mydriasis. The headaches were localized mainly at the left side of the nose, orbit, and upper forehead while the left ptosis was associated with blurred vision. Computed tomography angiography revealed an aneurysm in between the C4 segment of the left internal carotid artery (ICA) and the bifurcation of the left posterior communicating artery. Digital subtraction angiography further confirmed the aneurysm. We used the transarterial approach to assess the aneurysm and subsequent coiling. Iohexol (Omnipaque) contrast agent was used during the endovascular procedure. The patient’s condition deteriorated into acute confusion state with cardinal symptomology of CIEP immediately after the operation. Computed tomography scan revealed cortical contrast enhancement in the vascular territory of the ICA as well as edema. Her symptomatology resolved 48 hours after treated with anticonvulsants, intracranial pressure reduction and hydration. Chronic hypertension as well as type 2 diabetics may be critical predisposing factors to CIEP. CIEP should be suspected in patients presenting with acute confusion state after endovascular therapy. Massive edema with ischemic brain changes in white matter of the brain before endovascular procedure should rise suspicion of CIEP.
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7
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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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8
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Liu MR, Jiang H, Li XL, Yang P. Case Report and Literature Review on Low-Osmolar, Non-Ionic Iodine-Based Contrast-Induced Encephalopathy. Clin Interv Aging 2020; 15:2277-2289. [PMID: 33304098 PMCID: PMC7723034 DOI: 10.2147/cia.s280931] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/18/2020] [Indexed: 12/14/2022] Open
Abstract
Contrast-induced encephalopathy (CIE) is a rare complication following percutaneous carotid and coronary interventions, and important diagnostic radiological signs include brain edema and cortical enhancement. In this report, we detail a case of probable CIE in an 84-year-old woman following a normal diagnostic coronary angiography (CAG) that involved 20 mL of the low-osmolar, non-ionic monomeric, iodine-based contrast agent iopromide (Ultravist 370). The patient was unconscious and presented with hemiparesis, hemianopia, recurrent seizures, and cardiac and respiratory arrest within minutes to hours following the procedure. Non-contrast computed tomography (CT) of the head showed increased subarachnoid density, cortical enhancement, and brain edema in the right hemisphere. Three days of rehydration, reduction in cranial pressure, and treatment with an anticonvulsant and dexamethasone resulted in a gradual recovery with no neurological deficits. This case highlights that severe neurotoxic symptoms may occur in response to low doses of low-osmolar, non-ionic, monomeric contrast agents. This finding is of importance to interventional cardiologists for diagnostic considerations and development of treatment plans.
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Affiliation(s)
- Meng-Ru Liu
- Department of Cardiology, China-Japan Friendship Hospital, Peking Union Medical College, Chinese Academy of Medial Sciences, Beijing, People's Republic of China
| | - Hong Jiang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Xian-Lun Li
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Peng Yang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing, People's Republic of China
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9
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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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10
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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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11
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Ikemura A, Ishibashi T, Otani K, Yuki I, Kodama T, Kan I, Kato N, Murayama Y. Delayed Leukoencephalopathy: A Rare Complication after Coiling of Cerebral Aneurysms. AJNR Am J Neuroradiol 2020; 41:286-292. [PMID: 32001447 DOI: 10.3174/ajnr.a6386] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/27/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Delayed leukoencephalopathy is a rare complication that occurs after endovascular coiling of cerebral aneurysms. We aimed to describe a clinical picture of delayed leukoencephalopathy and explore potential associations with procedural characteristics. MATERIALS AND METHODS We considered endovascular coiling procedures for cerebral aneurysms performed between January 2006 and December 2017 in our institution with follow-up MRIs. We used logistic regression models to estimate the ORs of delayed leukoencephalopathy for each procedural characteristic. RESULTS We reviewed 1754 endovascular coiling procedures of 1594 aneurysms. Sixteen of 1722 (0.9%) procedures demonstrated delayed leukoencephalopathy on follow-up FLAIR MR imaging examinations after a median period of 71.5 days (interquartile range, 30-101 days) in the form of high-signal changes in the white matter at locations remote from the coil mass. Seven patients had headaches or hemiparesis, and 9 patients were asymptomatic. All imaging-associated changes improved subsequently. We found indications suggesting an association between delayed leukoencephalopathy and the number of microcatheters used per procedure (P = .009), along with indications suggesting that these procedures required larger median volumes of contrast medium (225 versus 175 mL, OR = 5.5, P = .008) as well as a longer median fluoroscopy duration (123.6 versus 99.3 minutes, OR = 3.0, P = .06). Our data did not suggest that delayed leukoencephalopathy was associated with the number of coils (P = .57), microguidewires (P = .35), and guiding systems (P = .57). CONCLUSIONS Delayed leukoencephalopathy after coiling of cerebral aneurysms may have multiple etiologies such as foreign body emboli, contrast-induced encephalopathy, or hypersensitivity reaction to foreign bodies.
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Affiliation(s)
- A Ikemura
- From the Department of Neurosurgery (A.I., T.I., K.O., I.Y., T.K., I.K., N.K., Y.M.), Jikei University School of Medicine, Tokyo, Japan
| | - T Ishibashi
- From the Department of Neurosurgery (A.I., T.I., K.O., I.Y., T.K., I.K., N.K., Y.M.), Jikei University School of Medicine, Tokyo, Japan
| | - K Otani
- From the Department of Neurosurgery (A.I., T.I., K.O., I.Y., T.K., I.K., N.K., Y.M.), Jikei University School of Medicine, Tokyo, Japan.,Siemens Healthcare K.K. (K.O.), Tokyo, Japan
| | - I Yuki
- From the Department of Neurosurgery (A.I., T.I., K.O., I.Y., T.K., I.K., N.K., Y.M.), Jikei University School of Medicine, Tokyo, Japan.,Department of Neurological Surgery (I.Y.), University of California Irvine, Irvine, California
| | - T Kodama
- From the Department of Neurosurgery (A.I., T.I., K.O., I.Y., T.K., I.K., N.K., Y.M.), Jikei University School of Medicine, Tokyo, Japan
| | - I Kan
- From the Department of Neurosurgery (A.I., T.I., K.O., I.Y., T.K., I.K., N.K., Y.M.), Jikei University School of Medicine, Tokyo, Japan
| | - N Kato
- From the Department of Neurosurgery (A.I., T.I., K.O., I.Y., T.K., I.K., N.K., Y.M.), Jikei University School of Medicine, Tokyo, Japan
| | - Y Murayama
- From the Department of Neurosurgery (A.I., T.I., K.O., I.Y., T.K., I.K., N.K., Y.M.), Jikei University School of Medicine, Tokyo, Japan
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12
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Nakagawa I, Park HS, Kotsugi M, Morisaki Y, Wada T, Aketa S, Takayama K, Fujimoto K, Deguchi J, Kichikawa K, Nakase H. Delayed Intracranial Parenchymal Changes After Aneurysmal Coil Embolization Procedures for Unruptured Intracranial Aneurysms. Oper Neurosurg (Hagerstown) 2019; 19:76-83. [DOI: 10.1093/ons/opz299] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/29/2019] [Indexed: 12/11/2022] Open
Abstract
Abstract
BACKGROUND
With the recent advances in endovascular treatment devices, it has become standard in wide-neck or large intracranial aneurysms to perform coil embolization with adjunctive techniques. However, device-related perioperative complications have been reported because of the use of more complex systems.
OBJECTIVE
To investigate patients who developed multiple parenchymal lesions after undergoing coil embolization for treating an unruptured intracranial aneurysm.
METHODS
This study investigated 305 consecutive patients who underwent coil embolization of unruptured intracranial aneurysms between 2015 and 2017. Delayed inflammatory changes referred to the delayed observation of multiple cerebral white matter lesions on follow-up magnetic resonance imaging at an area corresponding to the perfused area of the treatment target vessel. The timing and pattern of onset, device used, the combined use of adjunctive techniques, and the clinical course after steroid treatment were retrospectively investigated.
RESULTS
The 7 patients (2.3%) who showed delayed inflammatory changes were all women with a mean age of 59 yr. A mean duration from treatment to onset was 28 d. Symptoms were convulsions in 3 patients, hemiplegia in 2 patients, and homonymous hemianopia in 1 patient. All 7 patients were treated with adjunctive technique including stents, double catheter method, and balloon assist. Response to steroid treatment was satisfactory both clinically and on imaging in all 7 patients. Skin patch test was positive for nickel allergy in 2 patients.
CONCLUSION
Clinicians must be fully aware of symptomatic delayed inflammatory changes may occur after endovascular aneurysmal treatment with the use of various devices.
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Affiliation(s)
- Ichiro Nakagawa
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Hun Soo Park
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Masashi Kotsugi
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Yudai Morisaki
- Department of Neurosurgery, Nara Medical University, Nara, Japan
| | - Takeshi Wada
- Department of Radiology, Nara Medical University, Nara, Japan
| | - Shuta Aketa
- Department of Neurosurgery, Osaka Police Hospital, Osaka, Japan
| | - Katsutoshi Takayama
- Department of Radiology and Interventional Neuroradiology, Ishinkai Yao General Hospital, Yao, Japan
| | - Kenta Fujimoto
- Department of Neurosurgery, Osaka General Medical Center, Osaka, Japan
| | - Jun Deguchi
- Department of Neurosurgery, Nara City Hospital, Nara, Japan
| | | | - Hiroyuki Nakase
- Department of Neurosurgery, Nara Medical University, Nara, Japan
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13
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Arterial Spin Labeling Magnetic Resonance Imaging to Diagnose Contrast-Induced Vasospasm After Intracranial Stent Embolization. World Neurosurg 2019; 126:341-345. [DOI: 10.1016/j.wneu.2019.03.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
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14
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Montejo C, Rodríguez A, Pascual-Vicente M, Renú A. Transient contrast-induced encephalopathy after internal carotid artery embolisation prior to surgery for nasopharyngeal carcinoma. Neurologia 2018. [PMID: 29530435 DOI: 10.1016/j.nrl.2018.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- C Montejo
- Servicio de Neurología, Hospital Clínic de Barcelona, Barcelona, España
| | - A Rodríguez
- Servicio de Neurología, Hospital Clínic de Barcelona, Barcelona, España
| | - M Pascual-Vicente
- Servicio de Neurología, Hospital Clínic de Barcelona, Barcelona, España
| | - A Renú
- Servicio de Neurología, Hospital Clínic de Barcelona, Barcelona, España.
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15
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Hamra M, Bakhit Y, Khan M, Moore R. Case report and literature review on contrast-induced encephalopathy. Future Cardiol 2017. [PMID: 28621151 DOI: 10.2217/fca-2016-0075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Contrast-induced encephalopathy (CIE) is a rare neurological complication following the administration of injectable intravascular contrast media. Patients with CIE present a wide spectrum of symptoms such as headache, transient cortical blindness, seizure and focal neurological deficits. The diagnosis of CIE requires a high index of suspicion. Its early recognition is of paramount importance in instituting the appropriate supportive treatment in the form of intravenous fluids and also in avoiding unnecessary potentially harmful treatment such as intravenous thrombolysis for suspected ischemic stroke. Here, we report the case of a 62-year-old male patient with a typical presentation of CIE immediately following coronary angiography. We then continue to briefly review the relevant literature on CIE to date.
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Affiliation(s)
- Mardi Hamra
- Cardiology Department, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh, Scotland, EH16 4SA, UK
| | - Yasir Bakhit
- Cardiology Department, Freeman Hospital, Freeman Rd, Newcastle upon Tyne, NE7 7DN, UK
| | - Mahboob Khan
- Department of Stroke Medicine, Cumberland Infirmary, Newtown Rd, Carlisle, CA2 7HY, UK
| | - Roger Moore
- Cardiology Department, Cumberland Infirmary, Newtown Rd, Carlisle, CA2 7HY, UK
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Pagani-Estévez GL, Nasr DM, Brinjikji W, Perry A, Fugate JE. Dual-Energy CT to Diagnose Pseudoedema in Contrast-Induced Encephalopathy Following Cerebral Angiography. Neurocrit Care 2017; 27:261-264. [DOI: 10.1007/s12028-017-0394-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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