Repeated Injection of Contrast Medium Inducing Dysfunction of the Blood-Brain Barrier

Iwata, Tomonori; Mori, Takahisa; Tajiri, Hiroyuki; Miyazaki, Yuichi; Nakazaki, Masahito

doi:10.2176/nmc.53.34

Cited by 22 publications

(20 citation statements)

References 7 publications

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“…In terms of contrast medium used, while some reports describe the case with low doses, 10) many suggest that event is associated with the injected dose of the contrast medium and the number of injections. 11 – 13) Uchiyama et al reported that blood-brain barrier dysfunction is affected by the injection of high concentrations, low temperatures and repeated injections with short interval into the same blood vessel. 13) In this study, the mean dose of contrast medium was approximately 250 ml (mean 220 ml in hemodialysis and 285 ml in non-hemodialysis patients).…”

Section: Discussionmentioning

confidence: 99%

Contrast-induced Encephalopathy Following Embolization of Intracranial Aneurysms in Hemodialysis Patients

Matsubara

Izumi

Miyachi

et al. 2017

Neurol. Med. Chir.(Tokyo)

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Contrast-induced encephalopathy is a very rare complication associated with endovascular treatment of intracranial aneurysms. Patients with renal dysfunction may be prone to developing contrast medium neurotoxicity as a result of delayed elimination of the contrast medium in renal metabolism. This article focuses on our experience with contrast-induced encephalopathy in patients with end-stage renal disease requiring hemodialysis. The authors retrospectively reviewed five patients diagnosed with contrast-induced encephalopathy who underwent aneurysm coil embolization at their institution from January 2006 to December 2015. During the 10-year period, embolization was performed in 755 cases, among which contrast-induced encephalopathy occurred in five patients (0.66%). Three of the five patients were undergoing dialysis for chronic renal failure (one male and two female; mean age 66.7). Embolization for hemodialysis patients was performed in eight during the same period and the incidence of contrast-induced encephalopathy in hemodialysis patients is quite high in our series (3 of 8; 38%). Procedures were performed in one for recurrence of unruptured anterior-communicating artery aneurysm and in two for unruptured basilar-tip aneurysm. Mean approximately 220 ml of contrast media was used among three hemodialysis patients. All three patients showed an improvement or a control in symptoms soon after hemodialysis. Recovery of neurological symptoms was complete in two and almost normal in one within 1 week after intervention. Contrast-induced encephalopathy should be kept in mind as an expected complication of aneurysm embolization in hemodialysis patients. In hemodialysis patients with contrast-induced encephalopathy, performing hemodialysis is an effective treatment to improve symptoms early.

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Section: Discussionmentioning

confidence: 99%

Contrast-induced Encephalopathy Following Embolization of Intracranial Aneurysms in Hemodialysis Patients

Matsubara

Izumi

Miyachi

et al. 2017

Neurol. Med. Chir.(Tokyo)

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“…On follow-up CT, high-density areas disappear rapidly, often with resolution of symptoms. 18,19) In our patient, the head MRI findings resembled those of PRES, but the condition could be differentiated from PRES because the lesion was located in the unilateral frontotemporal region, high-intensity signals were detected on DWI, and abnormal signals did not disappear on follow-up MRI. Herpes encephalitis could also be differentiated from contrast-induced encephalitis because it occurred 30 days after endovascular treatment, and no high-density area was noted on head CT.…”

Section: Disclosure Statementmentioning

confidence: 55%

“…18,19) PRES is supposed to be caused by vascular edema primarily in the posterior circulation due to disruption of the blood-brain barrier. It is characterized by symptoms including headache, altered consciousness, convulsion, and cortical blindness.…”

Section: Disclosure Statementmentioning

confidence: 99%

A Case of Herpes Encephalitis Occurring after Aneurysmal Coil Embolization

Kuwayama

Matsuda

Hagino

et al. 2017

JNET

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Objective: We report a case of herpes encephalitis that occurred after coil embolization of cerebral aneurysm.Case Presentation: A 66-year-old woman underwent stent-assisted coil embolization for the recurrence of basilar tip aneurysm. She was discharged to home but noted fever 30 days after the procedure, and as she developed disorientation and disturbance of consciousness, she consulted the outpatient clinic of our hospital. MRI showed abnormal signals mainly in the mesial right temporal lobe, and with a diagnosis of herpes encephalitis based on the cerebrospinal fluid (CSF) tap test, acyclovir drip infusion was performed. While disturbance of consciousness was resolved, disorientation and short-term memory loss persisted. Conclusion:There is a possibility that herpes encephalitis was induced by the intracranial endovascular procedure.Herpes encephalitis should be recognized as a possible complication after intracranial endovascular therapy.

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“…Mechanisms such as disruption of the blood-brain barrier (BBB) caused by reperfusion and influx of a highconcentration contrast medium, and stagnation of the contrast medium due to insufficient recanalization of the capillaries despite recanalization of the major artery ("noreflow phenomenon") have been proposed. 13) Iwata et al 26) reported patients who developed HA after coil embolization for unruptured cerebral aneurysms and speculated that they were caused by disruption of the BBB by the contrast medium.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the CT High-density Area after Endovascular Treatment for Acute Ischemic Stroke

Takei

Irie

Tanaka

et al. 2017

JNET

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Objective: To evaluate the relationship between the incidence of the CT high-density area that appears immediately after endovascular treatment for acute ischemic stroke with postprocedural hemorrhagic transformation and its significance in the clinical outcome.Methods: Ten patients with ischemic stroke of the anterior circulation encountered between May 2014 and December 2015 in whom recanalization could be achieved within 8 hours after the onset were retrospectively analyzed. In addition, 695 patients presented in 13 reports were divided into thrombolysis and mechanical thrombectomy groups, and the postprocedural incidence of CT high-density areas was compared between the two groups.Results: Postprocedural CT high-density areas were observed in six (60%) of our patients. Hemorrhagic transformation occurred in three of them, but no exacerbation of neurological symptoms was noted. The incidence of postprocedural CT high-density areas was 43.1% (191/443) in the thrombolysis group and 71.8% (188/262) in the mechanical thrombectomy group including our patients, being significantly higher in the latter group (p <0.01). Conclusion:Although CT high-density areas appear more frequently after mechanical thrombectomy than after thrombolysis, they are considered to be infrequently developed into hemorrhagic transformation and exert relatively few negative effects on the neurological outcome.

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Repeated Injection of Contrast Medium Inducing Dysfunction of the Blood-Brain Barrier

Cited by 22 publications

References 7 publications

Contrast-induced Encephalopathy Following Embolization of Intracranial Aneurysms in Hemodialysis Patients

Contrast-induced Encephalopathy Following Embolization of Intracranial Aneurysms in Hemodialysis Patients

A Case of Herpes Encephalitis Occurring after Aneurysmal Coil Embolization

Evaluation of the CT High-density Area after Endovascular Treatment for Acute Ischemic Stroke

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