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

Abstract

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.

Contrast-induced encephalopathy and permanent neurological deficit following cerebral angiography: A case report and review of the literature

“…However, four of them were excluded because it was defined as allergic reactions, vasospasm, and posterior reversible encephalopathy syndrome, and complete data were not available in the other six papers. Finally, we accurately summarized 30 papers ( Leong and Fanning, 2012 ; Yan and Ramanathan, 2013 ; Kocabay et al, 2014 ; Nagamine et al, 2014 ; Hamra et al, 2017 ; Park et al, 2017 ; Spina et al, 2017 ; Dattani et al, 2018 ; Heemelaar et al, 2018 ; Hirata et al, 2018 ; Kahyaoğlu et al, 2018 ; Tong et al, 2018 ; Renault and Rouchet, 2019 ; Riahi et al, 2019 ; Şimşek et al, 2019 ; Zhao et al, 2019 , 2021 ; Fernando et al, 2020 ; Harada et al, 2020 ; Lei et al, 2020 ; Liu et al, 2020 ; Andone et al, 2021 ; Cristaldi et al, 2021 ; García-Pérez et al, 2021 ; Kamimura et al, 2021 ; Li et al, 2021 ; Vigano et al, 2021 ; Yao et al, 2021 ; Zhang et al, 2021 ; Rashid et al, 2022 ). A total of 127 patients were enrolled.…”

Contrast-induced encephalopathy following intra- arterial iodinated contrast media injection in patients with atherosclerotic cardiovascular disease: A retrospective analysis

“…Generally, CIE following intervention procedures is rare and sparsely documented in the literature. All previous studies [2][3][4][5][6][7][8][9][10][11][12][13] have mainly focused on the sporadic case reports. Therefore, the current study focuses on the patients with CIE following atherosclerotic cardiovascular disease (ASCVD).…”