Transient Contrast Neurotoxicity After Percutaneous Coronary Intervention Mimicking Subarachnoid Hemorrhage in a Patient With Chronic Kidney Disease

Şimşek, Ersin Çağrı; Ertürk, Elif; Ucar, Roza; Yilmaz, Artun Onat; Ekmekçi, Cenk; Mutlu, İnan; Sarı, Cenk

doi:10.1177/1179547619867671

Cited by 11 publications

(13 citation statements)

References 14 publications

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“…The origin of CIE is largely ascribed to its heightened viscosity, osmolarity, and direct neurotoxicity, which can result in aberrant blood-brain barrier functionality, an imbalance in cerebrospinal fluid electrolytes, cerebrovascular spasms, and direct neural cell damage. Etiological factors, contrast agent type, dosage, surgical timing, patient age, hypertension, hyperlipidemia, hyperglycemia, and a history of cerebrovascular lesions are among the various risk factors for CIE. [7,8] Based on their physicochemical structure, iodine contrast agents that are employed in clinical settings are presently categorized into the following groups: ionic monomers, for example, such as pantethine; ionic dimers, such as iodic acid; nonionic monomers, such as iodophoresol and iodofol; and nonionic dimers, such as iodixanol. [9] Nonionic iodine contrast agents are preferred due to their low incidence of adverse reactions.…”

Section: Discussionmentioning

confidence: 99%

After 3 months of medication balloon therapy, a patient who had contrast-induced encephalopathy recovered: A case report

et al. 2023

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Rationale: Iodinated contrast agents are extensively employed in clinical settings, with allergic reactions and renal impairment being the most prevalent adverse events. Contrast-induced encephalopathy (CIE) can present with heterogeneous clinical features, making diagnosis challenging. Prior studies on CIE have primarily documented rapid recovery within several days. However, this paper describes a case of CIE in a patient whose clinical symptoms took 3 months to fully abate. Patient concerns: A female patient, aged 54 years, received drug-coated balloon therapy for stenosis in a branch of the anterior descending coronary artery. Unfortunately, the patient developed CIE, which initially manifested as visual disturbances and subsequently progressed to gastrointestinal and limb movement issues, as well as an altered mental status, all of which occurred within a 24-hour period during hospitalization. Diagnoses: The patient was diagnosed with CIE after cerebral hemorrhage, and cerebral edema was ruled out based on the history of contrast medium administration and radiographic exams. Interventions and outcomes: Dexamethasone (10 mg/d), mannitol (100 mL/d), betahistine (500 mL), trazodone (25 mg), and hydration supplementation were given to treat CIE-related symptoms. Aspirin and clopidogrel were administered for the management of the cardiovascular ailment. The neurologist prescribed neurotrophic agents, namely, cytarabine and methylcobalamin, based on the cerebral magnetic resonance imaging findings. Despite the treatment, the patient’s ocular symptoms, including blurry vision, diplopia, and impaired intraocular retraction, persisted. Furthermore, the patient’s mental state was altered, and she continued to exhibit a depressive state during her 1-month follow-up visit. Lessons: CIE is a comparatively infrequent ailment, and its prompt identification and management are of paramount importance. Although the treatments for CIE are primarily symptomatic, it is crucial to acknowledge that the symptoms may not always subside quickly within a short duration. In conjunction with pharmacotherapy, counseling should be offered to address patients’ mental health.

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Section: Discussionmentioning

confidence: 99%

After 3 months of medication balloon therapy, a patient who had contrast-induced encephalopathy recovered: A case report

et al. 2023

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“…It is rare but occurs more frequently with the use of ionic contrast media as compared to nonionic contrast media [6] . Other risk factors include renal insufficiency, male sex, advanced age, hypertension, impaired kidney function, injection of large volumes of contrast media, and underlying brain disturbances [7].…”

Section: Discussionmentioning

confidence: 99%

Contrast Extravasation Mimicking Subarachnoid Hemorrhage After Cardiac Catheterization

Huda

Ahmed

Sampat

et al. 2020

Cureus

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Neurological complications after coronary angiography are rare but associated with significant mortality and morbidity. These include ischemic and hemorrhagic strokes, and transient ischemic attacks. Rarely, contrast media can cross the blood brain barrier causing transient neurological symptoms including confusion and seizures. On imaging, it can mimic a subarachnoid hemorrhage (SAH). Blood can be differentiated from contrast media using MRI. We present a patient who developed confusion after undergoing cardiac angiography and the initial CT of the brain showed SAH. However, MRI of the brain did not reveal any hemorrhage indicating contrast staining.

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“…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.…”

Section: Literature Reviewmentioning

confidence: 99%

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

Zhang

Zhang²,

Yuan³

et al. 2023

Front. Cell. Neurosci.

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Contrast-induced encephalopathy (CIE) is an uncommon complication associated with contrast exposure during angiographic procedures that is usually transient but occasionally leads to permanent complications or death. Due to the low incidence of CIE, there are still insufficient reports. This study was used to summarize the clinical features of CIE through a case report and systematic review. We summarized and reviewed 127 patients with CIE, and we found that the total incidence of CIE between men and women had no difference (49.61 and 50.39%, respectively), but the average age in female patients with CIE was older than that in male patients (62.19 and 58.77 years, respectively). Interestingly, the incidence of female patients with CIE in the poor prognosis group was significantly higher than that in the good prognosis group (62.50 and 36.51%, respectively), and the average age of these female patients in the poor prognosis group was younger than that in the good prognosis group (61.39 and 62.82 years, respectively). The contrast medium types were mainly nonionic (79.69 and 73.02%, respectively) and low-osmolar (54.69 and 71.43%, respectively) in both groups. Importantly, the total contrast media administrated in patients with poor prognoses was greater than that administrated in patients with good prognoses (198.07 and 188.60 ml, respectively). In addition, comorbidities in both groups included hypertension (55.91%), diabetes mellitus (20.47%), previous contrast history (15.75%), renal impairment (11.81%), and hyperlipidemia (3.15%). The percentage of patients with cerebral angiography was significantly higher in the poor prognosis group than that in the good prognosis group (37.50 and 9.52%, respectively), whereas the percentage of patients with coronary angiography in both groups had the opposite results (35.94 and 77.78%, respectively). In conclusion, CIE may not always have a benign outcome and can cause permanent deficits. Female gender, younger age, the higher dose of contrast medium, and the procedure of cerebral angiography may be related to the patient’s poor prognosis.

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Transient Contrast Neurotoxicity After Percutaneous Coronary Intervention Mimicking Subarachnoid Hemorrhage in a Patient With Chronic Kidney Disease

Cited by 11 publications

References 14 publications

After 3 months of medication balloon therapy, a patient who had contrast-induced encephalopathy recovered: A case report

After 3 months of medication balloon therapy, a patient who had contrast-induced encephalopathy recovered: A case report

Contrast Extravasation Mimicking Subarachnoid Hemorrhage After Cardiac Catheterization

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

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