Diagnostic Cerebral Angiography

Transient global amnesia is now considered a very rare complication of cerebral angiography. Various etiological mechanisms have been suggested to account for this complication, but no consensus has been reached yet. This case report documents one of the few reported cases of cerebral angiography-related transient global amnesia associated with magnetic resonance imaging (MRI) evidence of unilateral hippocampal ischemia, most probably as a consequence of a transient reduction in regional hippocampal blood flow. However, the possibility of a direct neurotoxic effect of the nonionic contrast media Iomeprol on the Cornu ammonis – field 1 neurons cannot be firmly ruled out.We describe the case of a 54-year-old woman admitted to our department for left upper limb weakness with acute onset 8 days before. The brain computed tomography (CT) scan performed at admission revealed subacute ischemic lesions in the right watershed superficial territories and a right thalamic lacunar infarct. Diagnostic digital subtraction cerebral angiography was performed 4 days after admission with the nonionic contrast media Iomeprol. A few minutes after completion of the procedure, the patient developed symptoms suggestive for transient global amnesia. The brain MRI performed 22 hours after the onset of symptoms demonstrated increased signal within the lateral part of the right hippocampus on the diffusion-weighted imaging (DWI) sequences, associated with a corresponding reduction in the apparent diffusion coefficient (ADC) and increased signal on the fluid-attenuated inversion recovery (FLAIR) sequences, consistent with acute hippocampal ischemia and several T2/FLAIR hyperintensities in the right watershed superficial territories and in the right thalamus, corresponding to the lesions already identified on the CT scan performed at admission. A follow-up MRI, performed 2 months later, demonstrated the disappearance of the increased signal within the right hippocampus on the DWI, T2/FLAIR, and ADC sequences.The precise mechanism of transient global amnesia related to cerebral angiography is still unclear, and further studies aimed to determine the definite pathophysiology of this syndrome and consequently to establish specific preventive measures are needed. Although the condition itself is considered to be self-limited, the long-term prognosis and the risk of recurrence in the cases where subsequent angiographic procedures are performed are not established yet.

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“…Very rare complications of the technique include transient global amnesia (TGA) and cortical dysfunction. 2 …”

Section: Introductionmentioning

confidence: 99%

Transient Global Amnesia After Cerebral Angiography With Iomeprol

Tiu

Terecoasa

Grecu³

et al. 2016

Medicine

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Velocity Criteria for Intracranial Stenosis Revisited

Zhao

Barlinn

Sharma

et al. 2011

Stroke

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116

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Background and Purpose-Intracranial atherosclerotic disease is associated with a high risk of stroke recurrence. We aimed to determine accuracy of transcranial Doppler screening at laboratories that share the same standardized scanning protocol. Methods-Patients with symptoms of cerebral ischemia were prospectively studied. Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) criteria were used for identification of Ն50% stenosis. We determined velocity cutoffs for Ն70% stenosis on digital subtraction angiography by Warfarin-Aspirin Symptomatic Intracranial Disease criteria and evaluated novel stenotic/prestenotic ratio and low-velocity criteria. Results-A total of 102 patients with intracranial atherosclerotic disease (age 57Ϯ13 years; 72% men; median NationalInstitutes of Health Stroke Scale 3, interquartile range 6) provided 690 transcranial Doppler/digital subtraction angiography vessel pairs. On digital subtraction angiography, Ն50% stenosis was found in 97 and Ն70% stenosis in 62 arteries. Predictive values for transcranial Doppler SONIA criteria were similar (PϾ0.9) between middle cerebral artery (sensitivity 78%, specificity 93%, positive predictive value 73%, negative predictive value 94%, and overall accuracy 90%) and vertebral artery/basilar artery (69%, 98%, 88%, 93%, and 92%). As a single velocity criterion, most sensitive mean flow velocity thresholds for Ն70% stenosis were: middle cerebral artery Ͼ120 cm/s (71%) and vertebral artery/basilar artery Ͼ110 cm/s (55%). Optimal combined criteria for Ն70% stenosis were: middle cerebral artery Ͼ120 cm/s, or stenotic/prestenotic ratio Ն3, or low velocity (sensitivity 91%, specificity 80%, receiver operating characteristic 0.858), and vertebral artery/basilar artery Ͼ110 cm/s or stenotic/prestenotic ratio Ն3 (60%, 95%, 0.769, respectively). Conclusions-At laboratories with a standardized scanning protocol, SONIA mean flow velocity criteria remain reliably predictive of Ն50% stenosis. Novel velocity/ratio criteria for Ն70% stenosis increased sensitivity and showed good agreement with invasive angiography. (Stroke. 2011;42:3429-3434.)

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Diagnostic Cerebral Angiography

Cited by 2 publications

References 67 publications

Transient Global Amnesia After Cerebral Angiography With Iomeprol

Transient Global Amnesia After Cerebral Angiography With Iomeprol

Velocity Criteria for Intracranial Stenosis Revisited

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