Contrast-induced encephalopathy presenting as acute subarachnoid hemorrhage

Pokersnik, Julie A.; Liu, Louisa; Simon, Erin L.

doi:10.1016/j.ajem.2018.03.005

Cited by 14 publications

(6 citation statements)

References 10 publications

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“…Repeated exposure to intravenous gadolinium is thought to have a cumulative effect over time with brain deposits that have been histopathologically confirmed in patients with normal renal function. Acute extravasation of gadolinium contents mimicking acute subarachnoid hemorrhage has also been described elsewhere, especially after intrathecal administration, including the patient in our case report [ 1 , 2 ]. There is, however, no clear consensus yet if these acute “high-dose” or gradually accumulating deposits result in long-term neurological sequelae.…”

Section: Introductionsupporting

confidence: 67%

“…The combination of CSF findings, relatively mild symptoms with absence of angiographic findings, and recent intrathecal contrast administration was suspicious for diffuse gadolinium extravasation rather than SAH. This presentation was described in a separate paper [ 2 ]. Patient was discharged home after a relatively short stay and established follow-up care in outpatient neurology practice.…”

Section: Case Presentationmentioning

confidence: 99%

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Long-Term Sequela of Intrathecal Gadolinium Extravasation: Symptoms Mimicking Post-concussive Syndrome

Patel¹,

Zolyan²,

Itrat³

2021

Cureus

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Gadolinium contrast administration, usually with magnetic resonance imaging, is an important diagnostic modality in the investigation of neurological pathologies. There is little evidence in the literature suggesting repeated exposure to intrathecal gadolinium results in symptoms mimicking post-concussive syndrome (PCS). We studied one patient who received intrathecal gadolinium to investigate a pain pump malfunction and presented with encephalopathic symptoms of confusion and aphasia with imaging consistent with intracranial gadolinium extravasation. The patient was followed up regularly with repeat imaging, reassessment of persistent symptoms, and specialist evaluations; however, symptoms remained refractory and resembled PCS. Our findings indicate a need to further investigate potential associations between intrathecal gadolinium exposure and a clinical presentation consistent with PCS, irrespective of histopathological changes.

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Section: Introductionsupporting

confidence: 67%

Section: Case Presentationmentioning

confidence: 99%

Long-Term Sequela of Intrathecal Gadolinium Extravasation: Symptoms Mimicking Post-concussive Syndrome

Patel¹,

Zolyan²,

Itrat³

2021

Cureus

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“…Contrast-induced encephalopathy (CIE) is a rare complication caused by administration of intravascular contrast media and characterized by acute reversible neurological disturbance. [ 1 ] Although it is most commonly seen after cerebral angiography, it has also been reported after contrast-enhanced computed-tomography (CT), cardiac and peripheral angiography. [ 2 ] CIE can cause a variety of neurological symptoms ranging from confusion and headache to more serious manifestations such as seizure, transient cortical blindness and focal neurological deficits.…”

Section: Introductionmentioning

confidence: 99%

“…[ 2 ] CIE can cause a variety of neurological symptoms ranging from confusion and headache to more serious manifestations such as seizure, transient cortical blindness and focal neurological deficits. Transient cortical blindness is the most frequently seen clinical presentation of CIE. [ 1 , 3 ] The prognosis of CIE can be extremely favorable. [ 4 ]…”

Section: Introductionmentioning

confidence: 99%

Cardiorespiratory arrest after iso-osmolar iodinated contrast injection

et al. 2021

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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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“…Preventing CIE involves identifying the patients at risk, minimizing the use of high doses of contrast agents, and opting for alternative imaging methods when possible, such as non-contrast MRI [ 34 ]. Close monitoring and a prompt recognition of CIE are crucial for timely management and optimal outcomes [ 35 ]. This includes a careful evaluation of the patient’s medical history and underlying risk factors before administering contrast media, the use of alternative imaging methods when possible, and the adjustment of the contrast dose or timing of the imaging procedures as necessary to minimize the risk of adverse effects [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

Contrast-Induced Encephalopathy in Patients with Chronic Kidney Disease and End-Stage Kidney Disease: A Systematic Review and Meta-Analysis

et al. 2023

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Background: Contrast-induced encephalopathy (CIE) is an infrequent but serious neurological condition that occurs shortly after the administration of contrast during endovascular and angiography procedures. Patients suffering from chronic kidney disease (CKD) or end-stage kidney disease (ESKD) are considered to be at a higher risk of contrast medium neurotoxicity, due to the delayed elimination of the contrast medium. However, the occurrence and characteristics of CIE in CKD/ESKD patients have not been extensively investigated. Methods: We conducted a comprehensive literature search, utilizing databases such as MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews, up to September 2022. The purpose was to identify documented cases of CIE among patients with CKD or ESKD. Employing a random-effects model, we calculated the pooled incidence and odds ratio (OR) of CIE in CKD/ESKD patients. Results: Our search yielded a total of eleven articles, comprising nine case reports and two observational studies. Among these studies, 2 CKD patients and 12 ESKD patients with CIE were identified. The majority of the CKD/ESKD patients with CIE (93%) had undergone intra-arterial contrast media and/or endovascular procedures to diagnose acute cerebrovascular disease, coronary artery disease, and peripheral artery disease. The male-to-female ratio was 64%, and the median age was 63 years (with an interquartile range of 55 to 68 years). In the two observational studies, the incidence of CIE was found to be 6.8% in CKD patients and 37.5% in ESKD patients, resulting in a pooled incidence of 16.4% (95% CI, 2.4%–60.7%) among the CKD/ESKD patients. Notably, CKD and ESKD were significantly associated with an increased risk of CIE, with ORs of 5.77 (95% CI, 1.37–24.3) and 223.5 (95% CI, 30.44–1641.01), respectively. The overall pooled OR for CIE in CKD/ESKD patients was 32.9 (95% CI, 0.89–1226.44). Although dialysis prior to contrast exposure did not prevent CIE, approximately 92% of CIE cases experienced recovery after undergoing dialysis following contrast exposure. However, the effectiveness of dialysis on CIE recovery remained uncertain, as there was no control group for comparison. Conclusions: In summary, our study indicates an association between CIE and CKD/ESKD. While patients with CIE showed signs of recovery after dialysis, further investigations are necessary, especially considering the lack of a control group, which made the effects of dialysis on CIE recovery uncertain.

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Contrast-induced encephalopathy presenting as acute subarachnoid hemorrhage

Cited by 14 publications

References 10 publications

Long-Term Sequela of Intrathecal Gadolinium Extravasation: Symptoms Mimicking Post-concussive Syndrome

Long-Term Sequela of Intrathecal Gadolinium Extravasation: Symptoms Mimicking Post-concussive Syndrome

Cardiorespiratory arrest after iso-osmolar iodinated contrast injection

Contrast-Induced Encephalopathy in Patients with Chronic Kidney Disease and End-Stage Kidney Disease: A Systematic Review and Meta-Analysis

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