Late Transient Contrast-Induced Encephalopathy after Percutaneous Coronary Intervention

Eleftheriou, Andreas; Rashid, Avan Sabir; Lundin, Fredrik

doi:10.1016/j.jstrokecerebrovasdis.2017.12.051

Cited by 10 publications

(8 citation statements)

References 17 publications

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“…Symptoms usually appear within minutes to hours after contrast administration, are serious, potentially including cortical blindness, seizures and focal neurological deficits, and are easy to identify and treat with interventions in the early stages [1]. In particular, Eleftheriou A et al reported a patient who was diagnosed withlate CIE at approximately 22 h after CAG [10]. In our case, the symptoms were mild at first and were therefore ignored by doctors.…”

Section: Discussionmentioning

confidence: 71%

“…In cases of CIE reported in the literature, the contrast media mostly consisted of high-and low-osmolality agents, such as iohexol, ioversol, and iopromide [1,[5][6][7]. Iso-osmolar contrast agents are not thought to cause CIE; however, cases of iso-osmolar contrast mediuminduced CIE (iodixanol) have been reported, though they are rare [8][9][10]. In our case, the patient presented CIE after cardiac catheterization with iodixanol, yet the cause was unclear.…”

Section: Discussionmentioning

confidence: 99%

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Recurrent epileptic seizures following cardiac catheterization with iodixanol: a case report

Pingping

Wei

Shi

et al. 2020

BMC Cardiovasc Disord

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Background: Contrast-induced encephalopathy (CIE) is a rare complication of cardiac catheterization; clinical manifestations include cortical blindness, seizures and focal neurological deficits. In general, recurrent epileptic seizures following cardiac catheterization with iodixanol occur more rarely than do other complications. Case presentation: Here, we report a case of a 76-year-old male patient who experienced unstable angina for nearly 10 months and was admitted to our hospital. Repeat cardiac catheterization was performed using iodixanol. At approximately 20 h after the first cardiac catheterization, his upper limbs began to exhibit slight trembling; the patient was conscious and could not control these movements. A total of 6 episodes occurred before the second cardiac catheterization was performed, with each episode lasting approximately 2 s. These symptoms were not treated. At approximately 2 h after the second cardiac catheterization, the symptoms became more severe, and the frequency of the episodes increased significantly; the symptoms had fully subsided at 6 h after the second operation. An electroencephalogram (EEG) demonstrated diffuse slowing with epileptiform abnormalities. Paroxysmal spike-wave and slow wave discharges were observed in the bilateral areas, and the abnormalities were marked in the frontal areas. These observations led us to conclude that the patient was experiencing epileptic seizures. During 6 months of monthly clinical follow-up visits after discharge, no abnormalities of the nervous system were found by cardiologists or neurologists, and the patient's EEG was normal. No antiepileptic drugs were administered throughout this process. Conclusions: CIE, especially recurrent epileptic seizures, is a rare but often reversible complication of cardiac catheterization with iodixanol. Its symptoms can be mild and therefore are easily ignored by physicians. Early CIE detection may be achieved by EEG. Repeated exposure to contrast agents carries the risk of recurrent epileptic seizures.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Recurrent epileptic seizures following cardiac catheterization with iodixanol: a case report

Pingping

Wei

Shi

et al. 2020

BMC Cardiovasc Disord

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“…[ 15 ] In fact, osmotic pressure and ionicity are not necessary to destroy the blood-brain barrier, because encephalopathy can also occur in the case of isotonic non-ionic contrast agent iodixanol. [ 16 , 17 ] In addition, physical factors such as increased intraluminal pressure caused by contrast injection may be one of the reasons for destroying the blood-brain barrier. Uncontrolled systemic blood pressure rises beyond the ability of cerebrovascular self-regulation.…”

Section: Discussionmentioning

confidence: 99%

Transient oculomotor paralysis after cerebral angiography

Qiu¹,

Dai

Gong³

et al. 2021

Medicine

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Rationale: A special case of transient oculomotor nerve palsy after cerebral angiography. Patient concerns: A 55-year-old man developed oculomotor nerve dysfunction after right radial artery puncture angiography. Diagnoses: Cerebral angiography-induced oculomotor nerve palsy. Interventions: According to the patient's disease state, intravenous drip of dexamethasone 10 mg/d. Outcomes: Magnetic resonance imaging (MRI) showed no abnormalities, and the patient recovered completely after 48 hours of hormone therapy. Lessons: Transient eye palsy caused by contrast agent encephalopathy is a clinically rare neurological dysfunction caused by adverse effects of contrast agents. Early prevention and correct treatment are critical.

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“…Other symptoms include headache, confusion, and convulsions 2 . The reported radiological findings on cerebral CT-imaging include (sub)cortical enhancement, mimicking of subarachnoid haemorrhage, and cerebral parenchymal swelling 3 , 11 , 12 . Also absence of radiological findings has been reported 13 …”

Section: Discussionmentioning

confidence: 99%

Acute-onset coma after iso-osmolar iodinated contrast injection: a case report of contrast-induced encephalopathy after elective coronary angiography

Heemelaar

Hoeven

Muller

et al. 2018

European Heart Journal - Case Reports

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BackgroundContrast-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 summaryA 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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Late Transient Contrast-Induced Encephalopathy after Percutaneous Coronary Intervention

Cited by 10 publications

References 17 publications

Recurrent epileptic seizures following cardiac catheterization with iodixanol: a case report

Recurrent epileptic seizures following cardiac catheterization with iodixanol: a case report

Transient oculomotor paralysis after cerebral angiography

Acute-onset coma after iso-osmolar iodinated contrast injection: a case report of contrast-induced encephalopathy after elective coronary angiography

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