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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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Vigano' M, Mantero V, Basilico P, Cordano C, Sangalli D, Reganati P, Lunghi A, Rigamonti A, Salmaggi A. Contrast-induced encephalopathy mimicking total anterior circulation stroke: a case report and review of the literature. Neurol Sci 2020; 42:1145-1150. [PMID: 33089478 DOI: 10.1007/s10072-020-04844-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Contrast-induced encephalopathy is a rare and usually reversible entity due to the administration of iodinated contrast. Clinical manifestations include cortical blindness, encephalopathy, seizures and focal neurological deficits. METHODS We report the case of a 56-year-old woman who developed global aphasia and right hemiplegia after a cerebral angiography performed for a subarachnoid haemorrhage. A prompt brain MRI resulted negative, while CT scan revealed left cerebral oedema with the cerebral sulci effacement. Complete recovery was observed in 10 days. DISCUSSION Diagnosis of contrast-induced encephalopathy requires a temporal correlation between neurological dysfunction and administration of iodinated contrast. Usually, the symptomatology is transient with a full recovery within 48-72 h. The most common symptom is cortical blindness, while other symptoms have been rarely reported. Only 20 cases previously reported global aphasia and/or hemiplegia or mimed anterior circulation strokes. Prompt brain neuroimaging is essential in order to exclude an alternative diagnosis that requires a distinct therapeutic approach.
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Affiliation(s)
- Martina Vigano'
- Neurological Department, "A. Manzoni" Hospital, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Vittorio Mantero
- Neurological Department, "A. Manzoni" Hospital, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy.
| | - Paola Basilico
- Neurological Department, "A. Manzoni" Hospital, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Christian Cordano
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Davide Sangalli
- Neurological Department, "A. Manzoni" Hospital, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Paolo Reganati
- Neuroradiological Unit, "A. Manzoni" Hospital, ASST Lecco, Lecco, Italy
| | - Alessandro Lunghi
- Neuroradiological Unit, "A. Manzoni" Hospital, ASST Lecco, Lecco, Italy
| | - Andrea Rigamonti
- Neurological Department, "A. Manzoni" Hospital, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
| | - Andrea Salmaggi
- Neurological Department, "A. Manzoni" Hospital, ASST Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy
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Zhang JX, Shi XY, Tang ZX, Sun H, Shen Z, Wan S. Acute communicating hydrocephalus caused by extravasation of digital subtraction angiography contrast medium: a case report and literature review. J Int Med Res 2020; 48:300060520945504. [PMID: 32757679 PMCID: PMC7412915 DOI: 10.1177/0300060520945504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
With the increasing use of endovascular technology in the treatment of various conditions, there has been an inevitable rise in cases with extravasation of contrast medium. We present a case in which extravasation of a large quantity of contrast medium resulted in acute communicating hydrocephalus. A 78-year-old woman came to the hospital because of abnormal right-sided limb movement, and was diagnosed with occlusion of the left internal carotid artery. The patient underwent timely intra-arterial mechanical thrombectomy. Postoperative computed tomography (CT) examination revealed a high-density shadow of the left basal ganglia and left frontal lobe. Twelve hours later, the patient fell into a coma. Repeat head CT indicated acute hydrocephalus with no evidence of obstruction. The patient underwent emergency external ventricular drainage, and the drainage fluid was observed to be clear. The patient regained consciousness after the procedure and the drainage tube was removed 4 days later. The patient had no recurrence of hydrocephalus. The mechanisms and treatment of this condition are discussed.
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Affiliation(s)
- Jin-Xia Zhang
- Department of Neurology, Hangzhou Dingqiao Hospital, Hangzhou, Zhejiang Province, China
| | - Xiao-Yong Shi
- Department of Neurosurgery, Zhejiang Hospital, Hangzhou, Zhejiang Province, China
| | - Zhu-Xiao Tang
- Department of Neurosurgery, Zhejiang Hospital, Hangzhou, Zhejiang Province, China
| | - Hu Sun
- Department of Neurosurgery, Zhejiang Hospital, Hangzhou, Zhejiang Province, China
| | - Zheng Shen
- Department of Neurosurgery, Zhejiang Hospital, Hangzhou, Zhejiang Province, China
| | - Shu Wan
- Department of Neurosurgery, Zhejiang Hospital, Hangzhou, Zhejiang Province, China
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Contrast-induced encephalopathy following cardiac catheterization. Catheter Cardiovasc Interv 2016; 90:257-268. [DOI: 10.1002/ccd.26871] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 11/01/2016] [Indexed: 11/07/2022]
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Contrast-induced encephalopathy after coronary angioplasty and stent implantation. ARCHIVES OF MEDICAL SCIENCES. ATHEROSCLEROTIC DISEASES 2016; 1:e63-e65. [PMID: 28905022 PMCID: PMC5421525 DOI: 10.5114/amsad.2016.61000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 06/15/2016] [Indexed: 12/11/2022]
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Abstract
Non-ionic agents have pharmacological side effects, such as seizure, alteration of cerebral function, confusion, short-term memory loss, mental aberrations and ophthalmoplegia. In this report, we present two cases that developed contrast-induced encephalopathy following coronary angioplasty by the non-ionic contrast agent, iopromide (Ultravist(®)). As a result, we concluded that iopromide-induced encephalopathy may occur during angioplasty in patients with no particular predispositions. In addition to that, contrast-induced encephalopathy should be considered as a new-onset neurological disorder.
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Affiliation(s)
- Gonenc Kocabay
- Kartal Kosuyolu Heart and Research Hospital, Istanbul, Turkey.
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Hemiplejia y afasia transitorias no tromboembólicas: ¿neurotoxicidad por contraste angiográfico? RADIOLOGIA 2009; 51:614-7. [PMID: 19853266 DOI: 10.1016/j.rx.2009.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Revised: 08/19/2009] [Accepted: 09/01/2009] [Indexed: 11/21/2022]
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González IA, Tapia C, Hernández-Luis C, San Román JA. Neurotoxicidad por contraste después de revascularización percutánea. Rev Esp Cardiol 2008. [DOI: 10.1157/13125005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Etgen T, Röttinger M, Martinoff S, Winbeck K, Sander D. Cerebral infarction combined with extensive contrast medium leakage after coronary angiography. J Neurol 2004; 251:1017-9. [PMID: 15316809 DOI: 10.1007/s00415-004-0473-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2003] [Revised: 02/27/2004] [Accepted: 03/08/2004] [Indexed: 11/28/2022]
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