Cervical myelopathy complicating cerebral angiography

Ramírez-Lassepas, Manuel; McClelland, Robert R.; Snyder, Bruce D.; Marsh, Donald G.

doi:10.1212/wnl.27.9.834

Cited by 10 publications

(2 citation statements)

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“…Since the 1970s, a total of 9 cases of CIS have been reported, including the case presented in this study (Table 1) in 21st century. [1][2][3][9][10][11][12] Notably, males exhibit a higher susceptibility to CIS following cerebral angiography, with a male-to-female ratio of 7:2. Furthermore, all affected patients were young or middle-aged individuals.…”

Section: Clinical Charactermentioning

confidence: 99%

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Contrast-medium injury of spinal cord after cerebral angiography using nonionic contrast agents: A case report and literature review

Zhuo,

Cao,

Yang

et al. 2023

Medicine

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Introduction: Contrast-induced spinal cord injury (CIS) is an uncommon yet severe neurological complication following cerebral angiography. It can lead to dire consequences, including limb paralysis, respiratory distress, and even death. Patient concerns: After undergoing cerebral angiography, a 41-year-old male initially displayed symptoms of dizziness and blurred vision, which advanced into dysphoria and limb weakness within 3 hours. These initial symptoms diminished by the 12th hour. Yet, 18 hours following the procedure, the patient developed quadriplegia and paresthesia below the T5 level, even though his deep sensory functions persisted unaffected. Diagnosis: The magnetic resonance imaging and diffusion weighted imaging scans excluded the presence of cerebrovascular ischemia or subarachnoid hemorrhage. However, the magnetic resonance angiography displayed arterial vasospasms in both posterior cerebral arteries and the V4 segment of the right vertebral artery. The encephalopathy symptoms faded within 12 hours, suggesting a probable contrast-induced encephalopathy diagnosis. An magnetic resonance imaging on day 4 revealed an intensified signal in the spinal cord from C1 to T1. This finding supported the diagnosis of CIS. Interventions: Following treatment with mannitol, methylprednisolone, and nimodipine, the patient’s contrast-induced encephalopathy symptoms resolved completely within 12 hours. With a 2-week regimen of aspirin, methylprednisolone, and rehabilitative training, the neurological symptoms from CIS showed steady improvement. Outcomes: The symptoms and signs of CIS gradually improved after 2 weeks’ treatment and rehabilitation program. Conclusion: Given the grave outcomes of CIS, like limb paralysis, breathing difficulties, and even fatality, it is imperative to remain cautious about this complication, even with the use of modern, less harmful contrast agents.

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Section: Clinical Charactermentioning

confidence: 99%

“…Numerous cases of CIS have been reported since the 1970s. [1][2][3] However, the incidence of CIS has significantly decreased with the adoption of nonionic contrast agents in recent times. The most recent reported case of CIS after cerebral angiography was in 2000, where an ionic contrast medium agent was employed.…”

Section: Introductionmentioning

confidence: 99%

Contrast-medium injury of spinal cord after cerebral angiography using nonionic contrast agents: A case report and literature review

Zhuo,

Cao,

Yang

et al. 2023

Medicine

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Spinal Angiography

Harrigan¹,

Deveikis²

2009

Handbook of Cerebrovascular Disease and Neurointerventional Technique

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Spinal Angiography

Harrigan

Deveikis

2012

Handbook of Cerebrovascular Disease and Neurointerventional Technique

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Catheter angiography of the spine is much less common than cerebral angiography, but it remains the gold standard for imaging spinal vasculature. Non-invasive imaging of spinal vasculature, including high resolution MRA or CTA, can sometimes be helpful to screen for larger vascular abnormalities, but fails to provide precise information regarding fl ow patterns and collateral fl ow; many times the vessels of interest are below the spatial resolution of these non-invasive modalities. Diagnostic spinal angiography is also typically done as the fi rst step during neurointerventional procedures involving the spine and spinal cord. The techniques and skills required for spinal angiography can overlap those required for cerebral angiography, since the upper cervical spine and spinal cord are supplied by the vertebral arteries. However, the spine extends from the base of the skull to the sacrum, and imaging the vasculature is a procedure entirely different from cerebral angiography. Indications1. Evaluation of patients with myelopathy, suspected to have spinal dural arteriovenous fi stulas (most common indication). 2. Evaluation of patients with known or suspected spinal arteriovenous malformations or vascular neoplasms (e.g., with spinal intramedullary or subarachnoid haemorrhages). 3. Rarely for evaluation of suspected spinal cord ischemia ischaemia (since cord blood supply is so variable, and treatment options for cord ischaemia are so limited, angiography is mainly done to rule out a fi stula as the cause of symptoms). 4. Planning for neurointerventional procedures on spine or spinal cord. 5. Pre-op mapping of cord vasculature prior to spinal or aortic procedures that risk occlusion of the spinal vessels. 6. Intra-operative assistance with surgery on spinal vascular lesions. 7. Follow-up imaging after treatment (e.g., after treatment of arteriovenous fi stulas or malformations). Complications of Diagnostic Spinal AngiographyInformed consent prior to an angiogram should include a discussion of the risk of complications. Neurological ComplicationsNeurological complications in spinal angiography may include the same risk of cerebral ischaemic events that may occur during cerebral angiography when the cervical region is being studied (see Chap. 2 ). In addition, there is the risk of vessel dissection, embolic occlusion with thrombus, atherosclerotic plaque, or air emboli occluding the spinal cord vessels and producing myelopathy. Forbes et al. reported that a series of 134 spinal angiograms had three (2.2%) neurological complications, all transient. spinal cord (although not necessarily performed as part of spinal angiography) has also been shown to produce temporary or permanent injury to the spinal cord. 4-6 Non-neurological ComplicationsNon-neurological complications of spinal angiography via the femoral artery include the same local and systemic complications seen in cerebral angiography (as seen in Chap. 2 ). Forbes reported 8.2% puncture-site complications and 3.7% systemic complications from spinal angiography.1 ...

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Cervical myelopathy complicating cerebral angiography

Cited by 10 publications

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Contrast-medium injury of spinal cord after cerebral angiography using nonionic contrast agents: A case report and literature review

Contrast-medium injury of spinal cord after cerebral angiography using nonionic contrast agents: A case report and literature review

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