Application of spectral CT in the diagnosis of contrast encephalopathy following carotid artery stenting: a case report

Abstract

Background Contrast encephalopathy is a rare complication of carotid artery stenting (CAS). Contrast encephalopathy is a diagnosis of exclusion that often needs to be distinguished from high perfusion syndrome, cerebral haemorrhage, subarachnoid haemorrhage (SAH), cerebral infarction and so on. Case presentation In this study, we report on a 70-year-old man who was admitted to the hospital with transient ischaemic attacks presenting paroxysmal weakness of limbs in the previous 2 years. He had severe stenosis of the left internal carotid artery diagnosed by digital subtraction angiography (DSA) and underwent CAS. Two hours after the operation, the patient developed paralysis of the right upper limb, unclear speech, fever and restlessness. Emergency skull computed tomography (CT) showed swelling and a linear high-density area in the left cerebral hemisphere. To clarify the components of this high-density area in the traditional CT, the patient had spectral CT, which made the diagnosis of the leakage of contrast clear. After 1 week of supportive treatment, the patient improved. Conclusions Spectral CT can easily distinguish the components of high-density areas on traditional CT, which is haemorrhage, calcification or iodine contrast leakage. Therefore, spectral CT is worth consideration for the differential diagnosis of complications of vascular intervention.

Development and validation of a predictive model for stroke associated pneumonia in patients after thrombectomy for acute ischemic stroke

“…Following thrombectomy, there is a risk of brain tissue ischemia–reperfusion injury, as well as stress-induced immune responses triggered by surgery and contrast agents. In a separate study, a rare complication of contrast agent encephalopathy was observed after carotid artery stent surgery ( 23 ). The underlying pathogenesis of this complication is currently unclear, but it may be associated with chemical toxicity and brain edema caused by the passage of contrast agents through the blood–brain barrier ( 23 ).…”

“…In a separate study, a rare complication of contrast agent encephalopathy was observed after carotid artery stent surgery ( 23 ). The underlying pathogenesis of this complication is currently unclear, but it may be associated with chemical toxicity and brain edema caused by the passage of contrast agents through the blood–brain barrier ( 23 ). All of these factors have the potential to alter the patient’s immune and inflammatory response, thus promoting the occurrence of SAP.…”