Contrast-Induced Encephalopathy Resulting From Use of Ioversol and Iopromide

Abstract

Background Contrast-induced encephalopathy (CIE) is a rare disease, whose etiology and risk factors remain unclear and need investigation. Methods We collected 7 CIE cases from 2646 patients injected with ioversol and 5 CIE cases from 526 patients injected with iopromide, all of whom underwent neurointervention surgery in our regional centers. The incidence of CIE, its characteristics, and risks were analyzed in both groups. Results The overall incidence of CIE was 0.38%, specifically 0.95% and 0.26% in the iopromide and ioversol groups, respectively; the former incidence was significantly higher than the latter (P = 0.029). The risk of CIE with iopromide was 3.567 to 3.618 times higher than that with ioversol (single-factor analysis odds ratio [OR], 3.618; 95% confidence interval [CI], 1.144–11.443; P = 0.029; multifactor analysis OR, 3.567 (95% CI, 0.827–15.379); P = 0.088). Moreover, acute cerebral infarction was an independent risk factor for CIE (OR, 4.024; 95% CI, 1.137–14.236; P = 0.031). Contrast-induced encephalopathy could occur within 5 minutes after injecting contrast media. The CIE characteristics differed according to the medium. In the ioversol group, the most common characteristic was visual disorder (71.43%), whereas in the iopromide group, the most common characteristic was delirium (100%). Conclusions Compared with ioversol, iopromide appeared more likely to lead to CIE. Acute cerebral infarction was an independent risk factor for CIE. The earliest CIE onset was within 5 minutes after injecting contrast. The characteristics of CIE varied significantly for different contrast media.

Flow diagram of the differential diagnosis and clinical decision making in a rare case of contrast-induced encephalopathy following cardiac catheterization: a case report

“…Currently, the understanding of CIE is that it is an acute reversible encephalopathy induced by contrast media and occurred within minutes to hours after the procedure. The risk factors may include advanced age, male sex, hypertension, renal failure, impaired cerebral autoregulation and transient ischemic attack, but no single factor can explain all cases [ 7 , 16 ]. In addition, the exact pathophysiology of CIE remains undetermined.…”

Low-dose Contrast-induced Encephalopathy During Diagnostic Cerebral Angiography

“…Previous reports have indicated that hypertension, renal disorder, and the low temperature of contrast agents might be risk factors for CIE (2,3,6). Acute cerebral infarction is also reported to be a risk factor for CIE (7). In addition, several reports have described CIE associated with endovascular surgery, which might require a higher dose of contrast agents.…”

Contrast-induced encephalopathy following intra- arterial iodinated contrast media injection in patients with atherosclerotic cardiovascular disease: A retrospective analysis

“…The shortest onset time was less than 5 minutes after contrast administration. The finding suggests that cerebral vasospasm and contrast-induced hypersensitivity may play essential roles in the pathogenesis of CIE. 79 Given these uncertainties and the rare occurrence of CIE, the definite recommendations beyond general safety measures are difficult to apply in all patients undergoing a procedure with contrast. However, we recommend that the contrast volume be kept to a minimum with the well-hydrated state of patients before and after the procedure.…”