Contrast‐induced encephalopathy following cardiac catheterization

Abstract

M a i l i n g A d d r e s s : F r e d e r i c o T. U l t r a m a r i @@@@@@@@@@@@@@@@@@@@@@@@@@@ It is estimated that 6,000 and 2,000 cardiac catheterization procedures per million inhabitants/year are performed in Western countries for diagnostic and therapeutic purposes. In order to perform these procedures, 1,800 tons of iodine are required all over the world to manufacture contrast media (CM). The number of procedures that require the use of contrast media (or dye) has increased over time, and the population submitted to it is growing older, presenting more comorbidities 1, 2. Currently low-osmolar contrast media are used in approximately 75% of patients and the iso-osmolar contrast media, allegedly less toxic are becoming more popular 1. In spite of development of new contrast media, they still represent the third main cause of nosocomial-acquired acute renal failure (ARF) (10% of cases), substantially increasing hospitalization period, care costs and in-hospital morbi-mortality 3-6. The main goal is to address important aspects about the contrast-medium induced nephropathy (CMIN) that follows cardiac catheterization, including its definition, pathogenesis, incidence, risk factors, clinical picture, prevention, treatment and prognosis.

Contrast-Induced Encephalopathy following Coronary Angiography with No Radiological Features: A Case Report and Literature Review

“…Typical radiological findings include cerebral oedema and cortical enhancement. Since the first clinical description in 1970, there have been 52 cases of CIE following cardiac catheterisation reported in the literature [16]. Here, we report a highly probable case of CIE post-CAG with no radiological findings on CT of the head and with spontaneous recovery.…”

“…Measuring the Hounsfield units (HU) on CT as an indicator of the density of the lesion in doubtful cases can assist in distinguishing haemorrhage from contrast extravasation since contrast presents a higher attenuation (80–160 HU) than blood (40–60 HU) [19]. The most frequently reported head CT finding in the literature is cortical or subcortical enhancement, but it has been reported that the enhancement resolves in 25 h in most cases [16]. Diagnosis of CIE is normally made by finding typical radiological signs on non-contrast CT in a symptomatic patient after excluding thromboembolic and haemorrhagic complications.…”

Acute ischemic stroke mimicking subarachnoid hemorrhage after coronary angioplasty

“…CM extravasation could mimic radiologically SAH which is likely to occur in cases in which more than one revascularization is performed [6]. The density of the lesion measured in Hounsfields units (HU) could be a useful distinguishing characteristic, which is confirmed in a recently published review of 53 published cases of "contrast induced encephalopathy" noting that blood density is ranging between 40 and 60 HU and contrast media usually between 100 and 300 HU [7]. Magnetic resonance imaging (MRI)-derived apparent diffusion coefficient (ADC) was shown as a reliable imaging modality that differentiates contrast extravasation from cerebral ischemia [8].…”

Contrast-induced encephalopathy after coronary angioplasty in a patient with ST-elevation myocardial infarction

“…CIE is a reversible neurological complication associated with contrast administration 1. In acute ischaemic or haemorrhagic stroke, abnormalities remain on follow-up imaging, whereas they disappear in CIE. CIE after PCI is an extremely rare complication 1. We emphasise the need for increased awareness of CIE in patients with acute coronary syndrome undergoing PCI.…”