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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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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.
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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.
| | - 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
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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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Mariajoseph FP, Lai L, Moore J, Chandra R, Goldschlager T, Praeger AJ, Slater LA. Pathophysiology of Contrast-Induced Neurotoxicity: A Narrative Review of Possible Mechanisms. Eur Neurol 2023; 87:26-35. [PMID: 38118425 PMCID: PMC11003557 DOI: 10.1159/000535928] [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: 09/21/2023] [Accepted: 12/18/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Contrast-induced neurotoxicity (CIN) is an increasingly observed event following the administration of iodinated contrast. It presents as a spectrum of neurological symptoms that closely mimic ischaemic stroke, however, CIN remains a poorly understood clinical phenomenon. An appreciation of the underlying pathophysiological mechanisms is essential to improve clinical understanding and enhance decision-making. METHODS A broad literature search of Medline (1946 to December 2022) and Embase (1947 to December 2022) was conducted. Articles discussing the pathophysiology of CIN were reviewed. SUMMARY The pathogenesis of CIN appears to be multifactorial. A key step is likely blood-brain barrier (BBB) breakdown due to factors including ischaemic stroke, uncontrolled hypertension, and possibly contrast agents themselves, among others. This is followed by passage of contrast agents across the BBB, leading to chemotoxic sequelae on neural tissue. KEY MESSAGES This review provides a clinically oriented review on the pathophysiology of CIN to enhance knowledge and improve decision-making among clinicians.
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Affiliation(s)
- Frederick P. Mariajoseph
- Department of Neurosurgery, Monash Health, Clayton, VIC, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Leon Lai
- Department of Neurosurgery, Monash Health, Clayton, VIC, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Justin Moore
- Department of Neurosurgery, Monash Health, Clayton, VIC, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Ronil Chandra
- Monash Imaging, Monash Health, Clayton, VIC, Australia
- Department of Radiology and Radiological Sciences, Monash University, Melbourne, VIC, Australia
| | - Tony Goldschlager
- Department of Neurosurgery, Monash Health, Clayton, VIC, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Adrian J. Praeger
- Department of Neurosurgery, Monash Health, Clayton, VIC, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Lee-Anne Slater
- Monash Imaging, Monash Health, Clayton, VIC, Australia
- Department of Radiology and Radiological Sciences, Monash University, Melbourne, VIC, Australia
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Jankovic D, Tanaka R, Sasaki K, Miyatani K, Chemate S, Nakipuria M, Tamura T, Komatsu F, Yamada Y, Kato Y. Contrast-Induced Encephalopathy after Endovascular Treatment: Two Case Reports. Asian J Neurosurg 2023; 18:813-817. [PMID: 38161601 PMCID: PMC10756802 DOI: 10.1055/s-0043-1776991] [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] [Indexed: 01/03/2024] Open
Abstract
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.
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Affiliation(s)
- Dragan Jankovic
- Department of Neurosurgery, University Medical Centre of the Johannes Gutenberg, University of Mainz, Mainz, Germany
- Faculty of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia
- Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Aichi, Japan
| | - Riki Tanaka
- Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Aichi, Japan
| | - Kento Sasaki
- Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Aichi, Japan
| | - Kyosuke Miyatani
- Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Aichi, Japan
| | - Sachin Chemate
- Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Aichi, Japan
- Department of Neurosurgery, Noble Hospitals, Pune, Maharashtra, India
| | - Mayank Nakipuria
- Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Aichi, Japan
- Department of Neurosurgery, Guru Teg Bahadur Hospital, New Delhi, India
| | - Takamitsu Tamura
- Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Aichi, Japan
| | - Fuminari Komatsu
- Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Aichi, Japan
| | - Yasuhiro Yamada
- Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Aichi, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University, Bantane Hospital, Nagoya, Aichi, Japan
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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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7
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Qiu L, Cui Q, Gong X, Zhou H. Anaphylaxis Following Contrast-Enhanced CT with Iodixanol: A Case Report and Literature Review. J Asthma Allergy 2023; 16:195-200. [PMID: 36721740 PMCID: PMC9884438 DOI: 10.2147/jaa.s386811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/10/2023] [Indexed: 01/26/2023] Open
Abstract
Background Iodixanol-induced anaphylactic reaction is a well-known adverse event of contrast agents, which are generally well-tolerated and reversible. Serious and fatal reactions such as anaphylactic shock after computed tomography (CT) enhancement have been described. However, there is no data on these events in the literature. Objective This report describes a case of a serious anaphylactic reaction, possibly related to iodixanol and provides an overview of case reports. Case Summary A 47-year-old women who experienced persistent abdominal pain for more than one month, was proposed of hiatal hernia with CT images taken two weeks previously and was admitted to the gastrointestinal surgery department. The patient underwent contrast-enhanced abdominal CT for the evaluation of multiple intraperitoneal hemodynamic features. A few minutes after abdominal enhanced CT scan, the patient was pale, sweating, had muscle tension and trembling, even coma and profound hypotension with 90/43 mm Hg. Immediately she was supported with oxygen inhalation, was treated with adrenaline subcutaneously, dexamethasone intravenously, and rapid intravenous drip of compound sodium chloride. Ten minutes later, the patient was in respiratory and cardiac arrest and the pupils were dilated. CPR and intermittant static push of 1 mg adrenaline were immediately carried. After endotracheal intubation, the patient's spontaneous heart rate and pupils recovered, and her blood pressure recovered to 105/53 mm Hg. It was suggested that the patient was suffering from iodixanol-induced anaphylactic shock and nephropathy, and she was transferred to the intensive care unit. Despite immediate treatment, the patient died. Conclusion A 47-year-old female patient with no history of allergies developed severe fatal anaphylactic shock after receiving iodixanol. Although contrast agents induced anaphylactoid/anaphylactic reactions do not often occur, clinicians should be conscious of the potentially serious anaphylactic reaction, which could lead to a life-threatening or fatal event.
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Affiliation(s)
- Lin Qiu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Qihao Cui
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Xuepeng Gong
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Haiyun Zhou
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
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Contrast-induced encephalopathy following bronchial arteriography and endovascular procedure. Acta Neurol Belg 2022; 123:717-719. [PMID: 35859227 DOI: 10.1007/s13760-022-02034-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/10/2022] [Indexed: 11/25/2022]
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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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Meijer FJA, Steens SCA, Tuladhar AM, van Dijk ED, Boogaarts HD. Contrast-induced encephalopathy-neuroimaging findings and clinical relevance. Neuroradiology 2022; 64:1265-1268. [PMID: 35290482 PMCID: PMC9117370 DOI: 10.1007/s00234-022-02930-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/08/2022] [Indexed: 11/16/2022]
Abstract
Contrast-induced encephalopathy (CIE) is a rare encephalopathic condition after the administration of a contrast agent. The diagnosis of CIE is challenging because of the heterogeneity and non-specificity of the clinical presentation. The clinical course is usually favorable with full recovery within 48–72 h in most patients, although comorbidity is of relevance and contributes to the clinical outcome. It is expected that the incidence of CIE is currently increasing, due to an increase in endovascular and diagnostic imaging procedures using iodinated contrast. It is important to include CIE in the differential diagnosis when patients deteriorate during, or immediately after, contrast administration, even when only a small amount of non-ionic contrast agent is used. When CIE is considered to be the most likely explanation for the clinical symptoms, it is advised to refrain from unnecessary additional contrast studies such as angiography or perfusion CT.
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Affiliation(s)
- Frederick J A Meijer
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Stefan C A Steens
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein 10, Postbus 9101, 6500 HB, Nijmegen, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Donders Center for Medical Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ewoud D van Dijk
- Department of Neurology, Donders Center for Medical Neurosciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hieronymus D Boogaarts
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
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11
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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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12
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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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Geng W, Yang Q, Wang W, Yin Q. The safety of iodixanol in interventional therapy for patients of different ages with cerebrovascular diseases. Am J Transl Res 2021; 13:8228-8234. [PMID: 34377310 PMCID: PMC8340189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/28/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We aimed to explore the therapeutic effect and safety of iodixanol in interventional therapy for patients of different ages with cerebrovascular diseases. METHODS A total of 132 patients undergoing interventional therapy for cerebrovascular diseases in our hospital were analyzed retrospectively. The patients were divided into the young adult group (≤44 years old, 44 cases), the middle-aged adult group (45-59 years old, 48 cases), and the older adult group (≥60 years old, 40 cases). All patients were treated with iodixsanol as the contrast agent for cerebrovascular interventional therapy. The patients' renal function (serum creatinine (SCr) and blood urea nitrogen (BUN) levels) before and after treatment and the incidence of adverse reactions were compared among the three groups. RESULTS At 48 h before operation, 2 h after operation and 48 h after operation, the levels of SCr and BUN in the older adult group were higher than those in the young adult group (all P<0.001), whereas the levels of SCr and BUN were similar between the older adult group and the middle-aged adult group and between the middle-aged adult group and the young adult group (all P>0.05). Within each group, the levels of SCR and BUN at 48 h before operation did not differ from those at 2 h and 48 h after operation (all P>0.05). No intergroup differences were found in the incidences of adverse reactions after using iodixanol for cerebrovascular interventional therapy (all P>0.05). CONCLUSION Iodixanol as a contrast medium shows good safety in interventional therapy for patients of different ages with cerebrovascular diseases; additionally, it has no significant impact on the renal function of patients and it leads to a low incidence of adverse reactions.
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Affiliation(s)
- Wanjie Geng
- Department of Neurology, Taihe County People's Hospital Fuyang, Anhui Province, China
| | - Qing Yang
- Department of Neurology, Taihe County People's Hospital Fuyang, Anhui Province, China
| | - Wei Wang
- Department of Neurology, Taihe County People's Hospital Fuyang, Anhui Province, China
| | - Qiduo Yin
- Department of Neurology, Taihe County People's Hospital Fuyang, Anhui Province, China
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14
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Cho WH, Lee JH, Lee TH, Choi CH, Ko JK. Unusual Magnetic Resonance Imaging Findings Contrast-induced Encephalopathy following Cerebral Angiography. KOSIN MEDICAL JOURNAL 2021. [DOI: 10.7180/kmj.2021.36.1.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
<p>Contrast-induced encephalopathy (CIE) following cerebral angiography has similar clinical presentations to ischemic complications of cerebral angiography. Neurologic deficits in CIE are mostly transient, but those caused by acute cerebral infarction (ACI) as ischemic complications of cerebral angiography may be permanent. Therefore, distinguishing CIE from ACI is important. Diffusion restriction on magnetic resonance imaging (MRI) implies ACI, while hyperintensity on diffusion weighted imaging (DWI) without correlation on the apparent diffusion coefficient (ADC) map implies CIE. We reported a rare case of CIE with diffusion restriction on MRI following cerebral angiography that mimicked MRI findings of ACI. The mechanism of this phenomenon remains unknown and requires further investigation.
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15
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Allison C, Sharma V, Park J, Schirmer CM, Zand R. Contrast-Induced Encephalopathy after Cerebral Angiogram: A Case Series and Review of Literature. Case Rep Neurol 2021; 13:405-413. [PMID: 34248578 PMCID: PMC8255655 DOI: 10.1159/000516062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/12/2021] [Indexed: 12/02/2022] Open
Abstract
Contrast-induced encephalopathy (CIE) is a rare complication that arises from exposure to iodinated contrast medium and can result in a range of symptoms, including cortical blindness, aphasia, focal neurological deficits, and altered mental status. We present 4 individual cases of CIE who presented with stroke-mimic symptoms following surgery with localized iodixanol or ioversol injection. We outline a clinical timeline of all patients, showing that CIE follows a general pattern of delayed onset, worsening symptomology, and ultimately full recovery. All patients received IV hydration, corticosteroids, or both as part of their treatment protocol.
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Affiliation(s)
- Cecelia Allison
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Vaibhav Sharma
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Jason Park
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Clemens M Schirmer
- Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA
| | - Ramin Zand
- Neuroscience Institute, Geisinger Health System, Danville, Pennsylvania, USA
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16
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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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17
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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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18
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Fernando TG, Nandasiri S, Mendis S, Senanayake S, Gooneratne IK, Navinan R, Kadiragamanathan A, Wickramasinghe S, Herath T, Thambirajah N, Markus R. Contrast-induced encephalopathy: a complication of coronary angiography. Pract Neurol 2020; 20:482-485. [DOI: 10.1136/practneurol-2020-002524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2020] [Indexed: 11/03/2022]
Abstract
Contrast-induced encephalopathy is a rare idiosyncratic reaction to contrast material. A 56-year-old woman with hypertension developed a hemiparesis with confusion and disorientation 3 hours after routine coronary angiography. The procedure had been prolonged, and during it she had received 130 mL of iopromide contrast. A metabolic screen was negative, and cerebral angiography and MR scan of brain were normal. She recovered completely by day 5. Contrast-induced encephalopathy should be considered in patients developing focal neurological deficits following coronary angiography. Patients requiring investigations to exclude acute stroke in this setting should not receive additional intravenous or intra-arterial contrast, although MR with gadolinium appears safe. Better awareness of this complication should avoid potentially harmful interventions such as thrombolysis.
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19
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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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20
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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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21
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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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22
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Abstract
The differential diagnosis of the patient with encephalopathy is broad and remains a common yet challenging problem for critical care physicians. A case is presented of contrast-induced encephalopathy in an 81-year-old man undergoing a left heart catheterisation after receiving iopamidol, a low-osmolar contrast agent. Immediately after receiving contrast, our patient experienced severe headache, agitation, altered mentation and significant skin hypersensitivity. This rare, acute and reversible neurological disturbance can be associated with administration of intra-arterial, osmotic, iodinated contrast. Although uncommon, it is important to recognise the various presentations, risk factors and treatment of this condition.
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Affiliation(s)
- Patrick Neilan
- Department of Internal Medicine, UF Health Shands, Gainesville, Florida, USA
| | - Daniel Urbine
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
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23
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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]
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