The clinical presentation of contrast-induced encephalopathy (CIE) varies widely, including altered mental status, focal motor and sensory deficit, visual disturbance, ophthalmoplegia, global aphasia, and seizures.Radiologically, CIE can mimic subarachnoid hemorrhage (SAH) on CT head with hyperdensity in the subarachnoid space due to iodinated contrast extravasation.CIE is a diagnosis of exclusion that requires comprehensive workup and close monitoring of neurologic examination. Case reportA 72-year-old woman with history of hypertension and hyperlipidemia presented with chest pain, lightheadedness, and diaphoresis. ECG revealed acute inferior myocardial injury and she was loaded with clopidogrel 600 mg and aspirin 81 mg and underwent emergent percutaneous coronary angioplasty for 100% occlusion of the right coronary artery with placement for 3 drugeluting stents. A total of 210 mL of iodinated contrast with low osmolarity (884 mOsm/kg) was used. There was no complication during the procedure. Immediately after the procedure, the patient was found to be confused. Head CT without contrast revealed hyperdensity (70 Hounsfield units [HU]) along right hemispheric gyri with mild cerebral edema, concerning for subarachnoid hemorrhage (SAH) (figure 1A). The patient was transferred to the intensive care unit at our institution for suspected hemorrhagic stroke. There was no report of seizure activity or acute or chronic renal dysfunction.