Case Report and Literature Review On contrast-induced Encephalopathy

Hamra, Mardi; Bakhit, Yasir; Khan, Muhammad; Moore, Roger K.

doi:10.2217/fca-2016-0075

Cited by 12 publications

(15 citation statements)

References 17 publications

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“…IV steroids and mannitol have been used sporadically with favorable outcomes. In patients with renal insufficiency on dialysis who develop CIE, hemodialysis has proven beneficial [5,8,9,11].…”

Section: Discussionmentioning

confidence: 99%

“…This supports the hypothesis that the symptoms are a result of the chemotoxic effect of hyperosmolar media resulting in microvascular sludging and arterial spasms, causing shrinkage of the endothelial cells and disruption of tight junctions. The accumulation of iodinated contrast has also been known to cause a localized neurotoxic effect on the blood-brain barrier by increasing the expression of endothelin, amplifying endothelial cell permeability, and resulting in cerebral edema [ 7 - 9 ]. However, in our case, the contrast was administered intravenously for a CTPE study.…”

Section: Discussionmentioning

confidence: 99%

“…Transient cortical blindness is the most common manifestation [ 10 ]. The literature review indicated that symptoms of neurological dysfunction presented within minutes to hours after contrast agent administration, and most patients fully recovered within 48-72 hours with supportive management [ 7 - 9 ]. In our patient, the symptoms resolved completely within 48 hours, which was consistent with the clinical course of CIE. We suspect that the severity of symptoms in our patient was related to her advanced age, hypertension, and other risk factors, which may have increased blood-brain barrier permeability, resulting in neurotoxicity and CIE.…”

Section: Discussionmentioning

confidence: 99%

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Contrast-Induced Encephalopathy: A Clinical Conundrum

Saha¹,

Mitra²

2022

Cureus

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Contrast-induced encephalopathy (CIE) is a rare but well-known complication of mostly intra-arterial contrast administration and presents with a variety of neurological deficits due to disruption of the bloodbrain barrier. We present a case of CIE after administration of intravenous contrast for computed tomography pulmonary angiogram (CTPE).A woman in her mid-70s with history of chronic obstructive pulmonary disease (COPD) presented with progressively worsening shortness of breath. She was diagnosed with multifocal pneumonia and started on IV antibiotics, IV steroids, and bilevel positive airway pressure (BiPAP) ventilation. A CTPE was done to rule out a pulmonary embolism during which she received 100 cc of Isovue 370 (iopamidol 76%), a low-osmolar, non-ionic, monomeric, iodine-based contrast agent. Within minutes of the contrast administration, the patient developed confusion and agitation with elevated blood pressure. Neurological evaluation revealed no gross focal motor or cranial nerve deficits and bilateral 2+ reflexes with mute plantar reflexes. Laboratory investigations were unchanged. She was shifted to the ICU but continued to remain drowsy and disoriented. CT brain done within two hours of onset revealed no intracranial abnormality. She was managed conservatively with IV fluids, neuro-checks, and blood pressure control. Her sensorium improved within 48 hours with supportive treatment. Repeat neuroimaging was not performed. She was discharged after four days with the resolution of her respiratory symptoms.CIE is a known but uncommon complication associated with the use of intraarterial contrast media but has been found to occur even after intravenous administration, which has been reported only once in literature. The presentation is highly variable, ranging from headache to coma, with transient cortical blindness being the most commonly identified. The diagnosis requires a high index of suspicion, and brain imaging is usually pathognomonic; however, cases in the absence of radiological signs have also been diagnosed. Typically, symptoms resolve within 48-72 hours and the disease runs a benign course, but cases of persistent neurological deficit and even cases of fatal cerebral edema have been reported. Treatment is usually supportive with intravenous hydration and anticonvulsants and the occasional use of IV steroids and mannitol with favorable outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Contrast-Induced Encephalopathy: A Clinical Conundrum

Saha¹,

Mitra²

2022

Cureus

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“…The incidence of CIE associated was estimated between 0.05 and 0.11% for diagnostic intravascular coronary angiography (ICA) and between 0.3 and 0.4% for percutaneous coronary intervention (PCI) ( 1 ). Its clinical manifestations are diverse, and the diagnosis of CIE is usually exclusionary ( 2 ). CIE can lead to various neurological symptoms within minutes to a few hours after the injection of contrast.…”

Section: Introductionmentioning

confidence: 99%

An unusual contrast-induced encephalopathy following percutaneous coronary intervention in patients with cerebrovascular abnormalities: A case report

Liao

Wang

Shao

et al. 2022

Front. Cardiovasc. Med.

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IntroductionContrast-induced encephalopathy (CIE) is a complication associated with the administration of iodinated contrast, which usually happens minutes to hours after contact with contrast, and fully recovers within 72 h. The clinical manifestations of CIE are diverse, and the pathological mechanism is not explicit.MethodsWe report the case of a 66-year-old female who suffered from a delayed CIE following the administration of iodinated contrast agent. Symptoms were severe. Imaging examination, biochemical and etiological detection were performed timely. The course of neurological symptoms was atypical. Her complex complications of hypothyroidism and cerebrovascular abnormalities contributed to more challenges, which were also clues to the diagnosis. With prompt and active treatment, the patient recovered fully over 10 days.DiscussionThe diagnosis standard of CIE highly depends on the association with the contact of contrast and the exclusion of other nervous system diseases. Complicated clinical circumstances and individual specificity can lead to different clinical manifestations of CIE, making it even more difficult to diagnose and treat. Prompt and dynamic imaging examination would provide great value in the diagnosis and evaluation of CIE. Timely diagnosis and intervention may be the key to its satisfying prognosis.

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“…Contrast-induced encephalopathy is an interesting and rare cause of encephalopathy that has been described as occurring after coronary or cerebral angiography. This condition has been associated with various neurological presentations including cortical blindness, seizure, encephalopathy, global aphasia, focal neurological deficits and even a chemical meningitis from extravasation of contrast media 1–10. Symptoms appear within minutes to hours after contrast injection and usually resolve within 72 hours as the contrast material is cleared by the kidney 11…”

Section: Introductionmentioning

confidence: 99%

A case of contrast-induced encephalopathy

Neilan

Urbine

2019

BMJ Case Rep

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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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Case Report and Literature Review On contrast-induced Encephalopathy

Cited by 12 publications

References 17 publications

Contrast-Induced Encephalopathy: A Clinical Conundrum

Contrast-Induced Encephalopathy: A Clinical Conundrum

An unusual contrast-induced encephalopathy following percutaneous coronary intervention in patients with cerebrovascular abnormalities: A case report

A case of contrast-induced encephalopathy

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