Contrast-Induced Encephalopathy Following Coronary Angioplasty with Iohexol

Abstract

We report a case of a patient who developed acute encephalopathy following coronary angioplasty with iohexol contrast. The patient's clinical condition was associated with slowing on the EEG. Studies did not reveal any other etiology or contributing cause for the encephalopathy. The patient recovered spontaneously in 24 hours with only supportive measures. This report suggests that such a drug reaction could occur with iohexol injected in the coronaries, but reassures that the encephalopathy is self limiting.

Contrast-Induced Encephalopathy following Coronary Angiography with No Radiological Features: A Case Report and Literature Review

“…In a few cases, anticonvulsants have been used to treat seizures [7, 14, 15] and steroids used to reduce cerebral oedema with no adverse consequences [13]. Symptoms usually appear within minutes to hours after contrast administration and resolve spontaneously within 72 h, as the contrast agent is cleared by the kidneys.…”

Incidental Intrathecal Injection of Meglumine Diatrizoate

“…Nowadays, lumbar myelography is not very common due to (serious complications like neurotoxicity (1), encephalopathy (2), cerebral edema (3), selective cortical injury (4), and transient partial amnesia (5) Magnetic Resonance Imaging. Although, an intact blood–brain barrier appears to protect the nervous system, some agents even though safe to give intravenously, being neurotoxic should not be instilled intrathecally (6).…”

“…Some authors consider the neurotoxicity as secondary to the volume of contrast medium used, as well as to the patient’s history of hypertension, which predisposed him to disruption of the BBB and cerebral autoregulatory dysfunction (10). Several case reports have documented neurotoxicity following angiography using nonionic contrast media, including encephalopathy (2, 3), cerebral edema (3), selective cortical injury (4), and transient partial amnesia (5). Later, ionic water-soluble media were developed.…”

Gadoliniumlu MRG tetkikleri ve girişimsel nöroradyolojik uygulamaların subaraknoid mesafeye kontrast madde sızıntısına etkisi

“…The hyperosmolality of iodinated contrast agent leads to a shrinkage in capillary endothelium cells and open the tight junctions among them, causing an increase in permeability of BBB. Resulting increase in vesicular transport is thought to result in contrast agent diffusion in CSF and electrolyte imbalance, which in turn induces acute encephalopathy (6). Plasma osmolality equivalent contrast agents of non-ionic dimer structure, which do not lead to an inducing hyperosmolality effect on BBB, have been reported to cause transient cortical blindness and global amnesia (7).…”

“…It is also known that iodinated contrast agent diffuses into SAS, mimicking hemorrhage and leading to neurotoxicity (5)(6)(7). Therefore, considering the increases in cerebrospinal fluid (CSF) signal or its density after contrast-enhanced radiological examinations, wrong diagnoses and aggressive treatments should be avoided.…”