Subarachnoid Hemorrhage Mimicking Leakage of Contrast Media After Coronary Angiography

Abstract

We report a patient who developed subarachnoid hemorrhage (SAH) just after coronary angiography (CAG) with non-ionic contrast media (CM) and minimal dose of heparin. The 55-year-old man had a history of acute ST elevation myocardial infarction that had been treated with primary percutaneous coronary intervention and was admitted for a follow-up CAG. The CAG was performed by the transradial approach, using 1000 U of unfractionated heparin for the luminal coating and 70 mL of iodixanol. At the end of CAG, he complained of nausea and rapidly became stuporous. Brain CT showed a diffusely increased Hounsfield unit (HU) in the cisternal space, similar to leakage of CM. The maximal HU was 65 in the cisternal space. No vascular malformations were detected on cerebral angiography. The patient partially recovered his mental status and motor weakness after 2 days. Two weeks later, subacute SAH was evident on magnetic resonance imaging. The patient was discharged after 28 days.

Contrast Extravasation Mimicking Subarachnoid Hemorrhage After Cardiac Catheterization

“…It results from disruption of the blood brain barrier. Contrast media neurotoxicity is usually short lived with rapid reversal [4]. It is rare but occurs more frequently with the use of ionic contrast media as compared to nonionic contrast media [6] .…”

“…With the development of more potent anti-platelet medications, there is also an increased risk of bleeding [3]. The incidence of major bleeding after coronary angiography is 2.7% and in patients with acute coronary syndrome undergoing percutaneous coronary intervention, the bleeding rate is about 18.1% [4]. In some cases, there is extravasation of contrast due to increased permeability of the blood brain barrier, mimicking an acute subarachnoid hemorrhage (SAH) on CT of the head [5].…”