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Mariajoseph FP, Lai LT, Moore J, Chandra RV, Goldschlager T, Praeger A, Slater LA. Current knowledge and perspectives of contrast-induced neurotoxicity: A survey of Australian clinicians. J Clin Neurosci 2023; 116:8-12. [PMID: 37597332 DOI: 10.1016/j.jocn.2023.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Contrast-induced Neurotoxicity (CIN) is an increasingly recognised complication following endovascular procedures. It remains a relatively unexplored clinical entity, and we sought to characterise clinician perspectives towards CIN, as well as identify gaps in knowledge and provide directions for future research. METHODS An online survey was distributed to members of the Australian and New Zealand Society of Neuroradiology, as well as several Australian tertiary hospitals. Questions related to clinical exposure to CIN, diagnosis, management and pathophysiology were explored. Descriptive analysis was conducted on survey responses, and statistical analysis was performed using Chi-square and Fisher's exact test as appropriate. RESULTS A total of 95 survey responses were recorded (26.8% response rate). Only 28.4% of respondents were comfortable in diagnosing CIN, and even fewer (24.2%) were comfortable in independently managing CIN patients. Based on clinician opinion, symptoms including impaired consciousness and cortical blindness were thought to be most associated with CIN, whilst the radiological findings of parenchymal oedema and cortical enhancement were considered to be most indicative of CIN. Most clinicians agreed that further investigation is required related to pathophysiology (86.3%), diagnosis (83.2%), and treatment (82.1%). CONCLUSION CIN is a poorly understood complication following endovascular procedures. Significant gaps in clinical understanding are evident, and further investigation is vital to improve diagnosis and management.
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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.
| | - 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
| | - Ronil V Chandra
- Monash Imaging, Monash Health, Clayton, Melbourne, Australia; Department of Radiology and Radiological Sciences, 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
| | - 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 and Radiological Sciences, Monash University, Melbourne, Victoria, Australia
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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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Heemelaar JC, van der Hoeven NW, Muller FF, Appelman Y. Acute-onset coma after iso-osmolar iodinated contrast injection: a case report of contrast-induced encephalopathy after elective coronary angiography. Eur Heart J Case Rep 2019; 2:yty132. [PMID: 31020208 PMCID: PMC6426011 DOI: 10.1093/ehjcr/yty132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 10/24/2018] [Indexed: 12/16/2022]
Abstract
Background Contrast-induced encephalopathy (CIE) is a rare complication of coronary angiography (CAG) caused by a direct neurotoxic reaction to iodinated contrast medium. Contrast-induced encephalopathy can result in a variety of neurological symptoms following within minutes to hours after contrast injection. It manifests most frequently as transient cortical blindness, headache, or confusion. In the majority of known cases, symptoms completely resolve solely with supportive care. We present a case where CIE takes a more dramatic course. Case summary A 67-year-old woman was scheduled for elective CAG, due to progressive typical chest pain. Within minutes after injection of iso-osmolar iodinated contrast medium, the patient showed a sudden decline in consciousness while all other vital functions remained normal. Shortly, after the patient was admitted to the intensive care unit due to acute-onset coma and respiratory insufficiency. A computed tomography scan of the brain showed bilateral cerebral oedema, which in combination with the development of symptoms after contrast injection led to the diagnosis of CIE. Remarkable decrease of cerebral oedema was observed 1 day later and slowly clinical recovery ensued. After 23 days, the patient was discharged from the cardiology ward. Follow-up at the outpatient clinic showed no lasting neurological deficits. Discussion While most symptoms of CIE are relatively mild and transient in nature, we describe a more devastating course that occurred with the use of only a low quantity of iso-osmolar contrast medium. We emphasize that even the more severe manifestations of CIE can develop at any dosage, and with all types of iodinated contrast medium.
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Affiliation(s)
- Julius C Heemelaar
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, HV Amsterdam, The Netherlands
| | - Nina W van der Hoeven
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, HV Amsterdam, The Netherlands
| | - Fenna F Muller
- Department of Neurology, VU University Medical Center, De Boelelaan 1117, HV Amsterdam, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, HV Amsterdam, The Netherlands
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4
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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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5
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Wilcock KE, Santamaria AB, Frankos VH, Fischer HW, Platz EA, Jackson BA. Perspectives on Adverse Reaction Rates Associated with the Use of High Osmolar Ionic and Low Osmolar Nonionic Contrast Media. ACTA ACUST UNITED AC 2016. [DOI: 10.3109/10915819009078764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- K. E. Wilcock
- ENVIRON International Corporation. 4350 North Fairfax Drive, Arlington VA 22203
| | - A. B. Santamaria
- ENVIRON International Corporation. 4350 North Fairfax Drive, Arlington VA 22203
| | - V. H. Frankos
- ENVIRON International Corporation. 4350 North Fairfax Drive, Arlington VA 22203
| | - H. W. Fischer
- Senior Lecturer, Radiology, Department of Radiology, University of Arizona, School of Medicine, Tucson AZ
| | - E. A. Platz
- ENVIRON International Corporation. 4350 North Fairfax Drive, Arlington VA 22203
| | - B. A. Jackson
- ENVIRON International Corporation. 4350 North Fairfax Drive, Arlington VA 22203
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Hayakawa K, Yamashita K, Mitsumori M, Nakano Y. Blood-Brain Barrier Injury following Intracarotid Injection of Radiographic Contrast Media. Acta Radiol 2016. [DOI: 10.1177/028418519003100218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Changes in signal intensity of the brain at magnetic resonance (MR) imaging before and after Gd-DTPA were used for in vivo quantification of injury to the blood-brain barrier (BBB). Immediately following intracarotid injection of 2 ml/kg of radiographic contrast medium (CM) 0.4 mmol/kg of Gd-DTPA was injected intravenously. MR imaging was performed with a 400/25 partial saturation pulse sequence. The maximum percentage changes (mean ± SD) in signal intensity of the brain after CM and Gd-DTPA were 1.6±1.6% with saline, 3.2 ± 2.0% with iotrolan, 4.3 ± 1.7% with iohexol, 6.6 ± 3.6% with ioxaglate and 8.2 ± 3.6% with diatrizoate. Not only the osmolality but also the ionicity and chemotoxicity seemed to influence Gd-DTPA leakage. A subtle BBB injury had a stronger tendency to occur in the basal ganglia than in the cerebral cortex. MR enhancement is proposed as a sensitive method for in vivo quantification of the BBB injury caused by intracarotid CM injection.
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Hayakawa K, Morris TM, Katzberg RW. Opening of the Blood-Brain Barrier by Intravenous Contrast Media in Euvolemic and Dehydrated Rabbits. Acta Radiol 2016. [DOI: 10.1177/028418518903000421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It has been suggested that intravenous injections of hypertonic contrast media when used in computed tomography and digital subtraction angiography might raise plasma osmolality sufficiently to open the blood-brain barrier (BBB). The current investigation establishes the threshold of plasma osmolality that causes the the opening of the BBB in euvolemic and dehydrated rabbits. Euvolemic rabbits were allowed food and water ad libitum. Dehydrated rabbits received 4.0 mg/kg of furosemide intramuscularly and were deprived of water for 72 hours. Meglumine/sodium diatrizoate 76 per cent (n=28) or mannitol 20 per cent (n= 12) was administrated intravenously, at a rate of 25 mmol/kg body weight/hour for 2, 3 or 4 hours. Plasma osmolality, blood iodine concentration, blood pressure, heart rate and hematocrit were assessed at regular intervals. Evans blue and 99Tcm-DTPA were used simultaneously as tracers for BBB opening. Rating of BBB opening with 99Tcm-DTPA correlated well with Evans blue staining (r=0.863, p<0.001; n=42). BBB opening was related to plasma osmolality and was similar for both contrast media and mannitol. Widespread BBB opening occurred above 400 mmol/kg while focal BBB opening occurred above 370 mmol/kg. Dehydration per se increased plasma osmolality but did not reduce the threshold for BBB opening.
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8
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Tiberio G, Giulini SM, Floriani M, Bonardelli S, Portolani N. Surgical Techniques from Intraoperative Angiographic and Velocimetric Controls in 43 Consecutive Carotid Bifurcation Endarterectomies. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153857448802200203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
From January to November, 1985, 43 carotid bifurcation endarterectomies (CE) were performed with intraoperative functional (Doppler spectrum analy sis) and morphologic (angiography) controls. In the first 20 cases, after thromboendarterectomy and direct suture, Dop pler showed absence of or no significant variations of frequency in 17 cases, a frequency increase corresponding to a less than 45% diameter reduction steno sis at the apex of the suture in 2 cases, and no flow in the internal carotid artery (ICA) in 1 case. Angiography confirmed the thrombosis in the above mentioned case and showed 3 less than 50% stenoses at the distal end of the arteriotomy: 2 already recognized by Doppler in small-size ICAs and 1 in a medium-size ICA without significant changes of flow. The reason for thrombosis was a distal intimal flap, which was successfully removed; the 2 stenoses in which Doppler and angiography agreed were corrected by patch angioplasty. In the last 23 cases, patch angioplasty was performed routinely in small-size ICAs (6 cases); in 1 case, first treated by a direct suture, Doppler and angiography showed a medium-grade stenosis, immediately corrected; in 1 case both techniques showed a 50% stenosis in a common carotid artery, immediately corrected. The execution of intraoperative angiography in this group of patients al lowed the authors to define the indication for the use of patch angioplasty, never previously employed. Nevertheless, the authors state that, on account of loss of time, costs, and exposure to radiations, intraoperative angiography must be reserved for those cases selected by Doppler spectrum analysis. This method seems to be highly sensitive in recognizing significant technical defects that could lead to an immediate or late failure.
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Affiliation(s)
- Giorgio Tiberio
- Department of Surgical Sciences, University of Brescia, Brescia, Italy
| | | | - Marco Floriani
- Department of Surgical Sciences, University of Brescia, Brescia, Italy
| | | | - Nazario Portolani
- Department of Surgical Sciences, University of Brescia, Brescia, Italy
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9
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Walker I, Coleman MD. The blood-brain barrier: In vitro methods and toxicological applications. Toxicol In Vitro 2012; 9:191-204. [PMID: 20650079 DOI: 10.1016/0887-2333(94)00202-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/1994] [Indexed: 12/16/2022]
Abstract
The blood-brain barrier (BBB) is reviewed with reference to in vitro cell culture models and their use and potential use in toxicological studies. The structure, function and in vitro study of brain microvessel endothelial cells (BMEC) is briefly described, as well as the effects of a number of xenobiotics, such as solvents, metals, polycations and herbicides, on the viability and barrier function of the BBB model. The biotransformation of xenobiotics is increasingly thought to be responsible for many toxic reactions seen in living systems. Few studies have addressed the effects of the products of biotransformation on the integrity of the barrier model. Many of the specific human bioactivating enzymes, such as cytochrome P-450s, can now be conveniently studied in eukaryotic in vitro gene expression systems. The combination of such systems with a well characterized porcine BMEC culture model might be useful in the study of reactive metabolites on the BBB, in terms of changes in indices of functional and structural BMEC viability. The potential applications and the value of such an experimental approach are discussed.
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Affiliation(s)
- I Walker
- Pharmaceutical Sciences Institute, Aston University, Birmingham B4 7ET, UK
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10
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Finke MD, Meola SD, Mazzaferro EM. Ascending tonic-clonic seizure syndrome in a dog following inadvertent intrathecal use of ionic contrast agent. J Vet Emerg Crit Care (San Antonio) 2012; 22:488-93. [PMID: 22809214 DOI: 10.1111/j.1476-4431.2012.00776.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 06/03/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the successful management of ascending tonic-clonic seizure syndrome in a dog after inadvertent intrathecal administration of ionic contrast material. CASE SUMMARY A 7-year-old, 5.9 kg, male castrated Miniature Pinscher inadvertently received intrathecal ionic contrast material during a myelogram to investigate cervical pain. Ascending tonic-clonic muscle spasms quickly progressed to generalized seizure activity that was resistant to anticonvulsant medications. The dog developed complete respiratory arrest, which necessitated mechanical ventilatory support for 26 hours. Pneumonia developed and was treated successfully. After resolution of seizure activity and resumption of voluntary respiration, the dog remained tetraparetic for 16 days and was not able to walk on his own for 20 days post contrast injection. Despite a prolonged recovery, the patient survived and recovered normal neurologic function. NEW OR UNIQUE INFORMATION PROVIDED Intrathecal administration of ionic contrast material resulting in ascending tonic-clonic seizure syndrome is rarely reported in the human and veterinary literature. No previous veterinary report has described successful treatment after prolonged respiratory arrest. In previous veterinary reports, patients recovered complete neurologic function within hours to days in contrast to this report in which the patient was tetraparetic for 16 days. This report demonstrates complete recovery from intrathecal ionic contrast administration is possible despite a high dose of contrast and a prolonged recovery.
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Affiliation(s)
- Maureen D Finke
- Wheat Ridge Veterinary Specialists, Wheat Ridge, CO, 80033, USA.
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Abstract
Transient cortical blindness is a rare complication of angiographic contrast use. A 64-year-old man experienced transient cortical blindness after subclavian arteriography for an occluded axillofemoral graft. The literature on transient cortical blindness is reviewed.
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Affiliation(s)
- L A Boyes
- Department of Radiology, Townsville General Hospital, Queensland, Australia
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12
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Vranckx P, Ysewijn T, Wilms G, Heidbüchel H, Herregods MC, Desmet W. Acute posterior cerebral circulation syndrome accompanied by serious cardiac rhythm disturbances: a rare but reversible complication following bypass graft angiography. Catheter Cardiovasc Interv 1999; 48:397-401. [PMID: 10559823 DOI: 10.1002/(sici)1522-726x(199912)48:4<397::aid-ccd16>3.0.co;2-c] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Cerebral events are recognized, although infrequent, complications of cardiac catheterization. We report on an exceptional case of a posterior cerebral circulation syndrome comprising a confusional state, amnestic disturbances, aphasia, and cortical blindness, accompanied by life-threatening cardiac arrhythmia after left and right internal mammary artery graft angiography, with complete recovery over 5 days. The diagnostic potential of computed tomography, magnetic resonance, and SPECT imaging of the brain in diagnosing this rare but important complication is illustrated. The need for early continuous monitoring of patients with clinically important cerebrovascular events postangiography is emphasized. Cathet. Cardiovasc. Intervent. 48:397-401, 1999.
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Affiliation(s)
- P Vranckx
- Department of Cardiology, University Hospital Gasthuisberg, University of Leuven, Leuven, Belgium
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13
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Killeffer JA, Kaufman HH. Inadvertent intraoperative myelography with Hypaque: case report and discussion. SURGICAL NEUROLOGY 1997; 48:70-3. [PMID: 9199689 DOI: 10.1016/s0090-3019(96)00156-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Myelography is routinely performed safely using nonionic water-soluble radiographic contrast media. However, inadvertent introduction of ionic contrast media into the thecal space can result in a syndrome of spasms and convulsions, which can lead to death if not recognized and dealt with in a timely manner. METHODS We report a case of inadvertent use of the ionic diatrizoate meglumine, an ionic contrast agent, instead of a nonionic contrast agent during intraoperative myelography. RESULTS The patient developed a sterotypical syndrome of ascending myoclonic spasms, resulting in rhabdomyolysis. Treatment included elevation of the head, removal of cerebrospinal fluid, administration of anticonvulsants, diuresis and sedation, and neuromuscular blockade. The patient recovered well, and there were no long-term sequelae. CONCLUSIONS Intrathecal introduction of ionic contrast media and the resultant syndrome must be recognized promptly and treated with aggressive medical management to address rhabdomyolysis and seizures. Ionic contrast media should be stored and marked in such a way as to avoid inadvertent use in myelography.
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Affiliation(s)
- J A Killeffer
- Department of Neurosurgery, West Virginia University School of Medicine, Morgantown 26506-9183, USA
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14
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Antonellis J, Kostopoulos K, Rambaouni A, Margaris N, Kranidis A, Salahas A, Ifantis G, Koroxenidis G. Cortical blindness following coronary arteriography: a rare but self-cured complication. Two case reports. Angiology 1996; 47:803-6. [PMID: 8712484 DOI: 10.1177/000331979604700808] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The rare and self-cured complication of cortical blindness following coronary arteriography is presented in 2 patients who underwent cardiac catheterization. Both patients were submitted to an aortocoronary bypass grafting procedure a few years before and were under clinical investigation for a new onset of unstable angina pectoris.
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Affiliation(s)
- J Antonellis
- Hemodynamic and Interventional Cardiology Unit, Evangelismos General Hospital, Athens, Greece
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15
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Wong KS, Liang EY, Lam WW, Huang YN, Kay R. Spiral computed tomography angiography in the assessment of middle cerebral artery occlusive disease. J Neurol Neurosurg Psychiatry 1995; 59:537-9. [PMID: 8530943 PMCID: PMC1073721 DOI: 10.1136/jnnp.59.5.537] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
There has been no report on the use of spiral computed tomography angiography (CTA) in the investigation of intracranial cerebral artery stenosis. A prospective pilot study was conducted to investigate the feasibility of CTA in the diagnosis of intracranial occlusive disease and its correlation with transcranial Doppler. With transcranial Doppler, 10 patients with acute ischaemic stroke with middle cerebral artery stenosis or occlusion were identified. There were seven middle cerebral artery stenoses and five middle cerebral artery occlusions. The CTA confirmed all diagnoses by transcranial Doppler except in one patient with middle cerebral artery occlusion in whom the embolus had probably propagated. The results showed that CTA is feasible and potentially useful in the diagnosis of middle cerebral artery occlusive disease. Further studies are required to assess its validity, sensitivity, and specificity in the diagnosis of middle cerebral artery occlusive disease.
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Affiliation(s)
- K S Wong
- Department of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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16
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Kamata J, Fukami K, Yoshida H, Mizunuma Y, Moriai N, Takino T, Hosokawa S, Hashimoto K, Nakai K, Kawazoe K. Transient cortical blindness following bypass graft angiography. A case report. Angiology 1995; 46:937-46. [PMID: 7486215 DOI: 10.1177/000331979504601009] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Transient cortical blindness, an uncommonly recognized complication of cerebral angiography, is an exceedingly rare event after cardiac catheterization and angiography. This report describes a sixty-two-year-old patient who had transient cortical blindness following bypass graft angiography. In this case, the authors showed that cortical blindness was associated with the breakage of the blood-brain barrier (BBB) and an increase in vascular permeability rather than with primary cerebral circulatory insufficiency. When the possibility exists that an excess volume of contrast medium may enter the cerebral circulation as in this case, that is, following a coronary artery bypass graft (CABG) using the internal mammary artery (IMA), precautionary measures may be necessary such as changing the type of contrast medium to be used or decreasing the volume injected. When cortical blindness occurs, it is a serious clinical problem whether transient or permanent. Therefore, the circumstances leading to this complication should be understood to determine suitable treatment and management.
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Affiliation(s)
- J Kamata
- Second Department of Internal Medicine, Iwate Medical University, Morioka, Japan
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17
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Tillson DM, Roush JK, McMurphy RM, Ammon PE. INADVERTENT INTRATHECAL ADMINISTRATION OF DIATRIZOATE MEGLUMINE AND DIATRIZOATE SODIUM DURING MYELOGRAPHY IN A DOG. Vet Radiol Ultrasound 1994. [DOI: 10.1111/j.1740-8261.1994.tb00193.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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18
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Maruyama K, Setoguchi Y, Maruyama J, Shimizu T, Chikusa H, Takeuchi M, Ogihara Y, Muneyuki M. Intrathecal injection of high-dose meglumine amidotrizoate with complete recovery. Intensive Care Med 1993; 19:232-4. [PMID: 8366232 DOI: 10.1007/bf01694776] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Rarely we are faced with accidental spinal injection of potentially toxic substances. We present 2 cases in which amidetrizoate, water-soluble ionic contrast medium, was accidentally injected intrathecally. Our treatment consisted of vigorous hydration and barbiturate coma. This report suggests that for water-soluble ionic contrast media increasing cerebrospinal fluid circulation by vigorous hydration may be as effective as spinal lavage in diminishing toxicity.
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Affiliation(s)
- K Maruyama
- Department of Anesthesiology, Mie University Hospital, Japan
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19
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Corrado AP, Ballejo G, Antunes E, de Nucci G. Mechanism of pain induced by radiocontrast media. Toxicol Lett 1992; 64-65 Spec No:739-43. [PMID: 1281941 DOI: 10.1016/0378-4274(92)90255-i] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
In lightly-anesthetized dogs, ionic or non-ionic RCM (Iotalamato and iohexol, respectively) when injected by intracarotid route (i.c.), elicit a pain response comparable to that caused by bradykinin (BK) or capsaicin (CAP). This response, which is characterized by vocalization, hyperpnea, bradycardia and neck muscle contraction, was dose dependent and related to the osmolarity of the RCM. In the present study we observed that indomethacin did not interfere with CAP and RCM-induced pain at dose (2 mg/kg i.c.) that reduced BK-elicited responses. In contrast, Ruthenium Red (RR), in dose (1 mg/kg i.c.) that reduced CAP and/or RCM-induced effects did not affect BK-induced phenomena. We also verified that L-NAME (50 mg/kg i.c.) reduced the BK-, but not the CAP- and/or RCM-induced pain responses which suggests that an L-arginine-derived NO or related compound is involved in BK activation of perivascular nociceptors. Indeed, we found that i.c. injection of 20 mg of S-nitrosocysteine, a putative EDRF, caused BK-like responses. On the other hand, RCM and CAP appear to activate the same RR sensitive ionic channels of primary afferent endings. Therefore, RR-analogues could constitute a novel approach to minimizing or eventually abolishing the RCM side effects.
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Affiliation(s)
- A P Corrado
- Department of Pharmacology, School of Medicine of Ribeirao Preto, University of São Paulo, Brazil
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20
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Abstract
It has taken many years of research, development and intense scientific investigation to produce intravascular contrast media. Research on relations between chemical structure, animal toxicity, and water-solubility has produced a number of highly water-soluble, iodinated compounds for use in diagnostic radiology as intravascular contrast agents. The currently used intravascular agents may be classified into four groups according to their chemical structure: 1. Ionic monomers 2. Ionic monoacid dimers 3. Nonionic monomers 4. Nonionic dimers It is the objective of this publication to review the history and development of intravascular contrast media as well as their properties, general effects and clinical use. The four types of contrast media differ significantly in their chemical structure and physico-chemical properties, and these differences determine their osmotoxicity, chemotoxicity, and ion toxicity. We analyze the organ specific toxic effects of intravascular contrast media upon the central nervous system, the cardiovascular system, and the renal system. We also review the secondary effects, clinical manifestations, and the incidence of adverse events associated with different types of contrast. The choice of contrast media has become critical since the introduction of nonionic agents because their toxicological and pharmacological properties differ from those of the ionic agents. The application of basic concepts involved in the use of contrast media in excretory urography, computed tomography, angiography, and angiocardiography is discussed, and the advantages of the use of nonionic contrast agents are outlined. Economic and ethical issues are presented with emphasis upon strategies to reduce the risk associated with the injection of intravascular contrast and to curtail consumption according to rational principles of use.
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Affiliation(s)
- H O Stolberg
- McMaster University Medical School, Hamilton General Hospital, Ontario, Canada
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21
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Hilz MJ, Huk W, Schellmann B, Sörgel F, Druschky KF. Fatal complications after myelography with meglumine diatrizoate. Neuroradiology 1990; 32:70-3. [PMID: 2333138 DOI: 10.1007/bf00593948] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A case of inadvertent intrathecal injection of diatrizoate meglumine is presented. After myelography with 10 ml i.e. 6.5 g Angiografin, a 76-year-old man rapidly developed myoclonus, drowsiness and excessive metabolic acidosis. He died only a few hours later. Postmortem showed non-specific brain edema. RP-HPL-Chromatography confirmed high concentration of the contrast medium in CSF (6 mg/ml) which must have induced refractory central nervous dysregulation. The lethal effects of the misapplication of this agent on the nervous system are discussed.
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Affiliation(s)
- M J Hilz
- Department of Neurology, University of Erlangen-Nürnberg, Federal Republic of Germany
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22
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Henzlova MJ, Coghlan HC, Dean LS, Taylor JL. Cortical blindness after left internal mammary artery to left anterior descending coronary artery graft angiography. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1988; 15:37-9. [PMID: 3409312 DOI: 10.1002/ccd.1810150108] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We describe a case of transient cortical blindness following internal mammary artery to left anterior descending coronary artery graft angiography. This dramatic, infrequent, and self-limiting complication so far has not been described in the cardiovascular literature. In the present era of internal mammary artery use for the left coronary artery grafting, the angiographer should be familiar with the diagnosis, prevention, and management of complications previously seen mostly during the posterior cerebral circulation angiography.
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Affiliation(s)
- M J Henzlova
- Department of Medicine, University of Alabama, Birmingham 35294
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