Irreversible fatal contrast-induced encephalopathy: a case report

Abstract

Background Contrast-induced encephalopathy (CIE) is a well-known complication of iodinated contrast agents during angiography and vascular interventions. It can manifest as hemiparesis, cortical blindness, speech changes, Parkinsonism, confusion, seizure, and coma. Most of the reported CIE cases have been transient and reversible. Irreversible fatal CIE cases have been rarely reported. All the fatal CIE cases reported involved the use of ionic high osmolar contrast agents. Here, we document a heretofore unreported fatal CIE after digital subtraction angiography (DSA) using iopamidol, which is a type of non-ionic monomer low osmolar contrast agent. Case presentation A 71-year-old woman was admitted to our Department of Neurology for tinnitus in the head. The cerebral magnetic resonance angiography (MRA) detected atherosclerotic cerebral arteries and bilateral stenosis of the middle cerebral arteries. The patient underwent DSA for further diagnostic work-up. The total amount of iopamidol used during the procedure was 110 ml. The patient experienced headache during the procedure, followed by dizziness with nausea and vomiting. Despite treatment with anti-oedema medications, her clinical status was gradually deteriorating and ended up with deep coma due to irreversible cerebral oedema which was confirmed by cerebral computed tomography (CT). Finally, the patient died 56 days after the procedure due to irreversible fatal cerebral oedema. Conclusions This report documents that iopamidol-induced encephalopathy may not always have a benign outcome and can result in irreversible fatal cerebral oedema.

<p>Case Report and Literature Review on Low-Osmolar, Non-Ionic Iodine-Based Contrast-Induced Encephalopathy</p>

“… 53–55 Recently, a small body of literature has shown that low osmotic pressure contrast agents can induce permanent neurological dysfunction 4 and fatal cerebral edema. 56 In our case, the patient developed recurrent seizures and cardiac and respiratory arrest, but her neurological symptoms gradually improved after 3 days in response rehydration, anticonvulsant therapy, reduction of cranial pressure, and treatment with dexamethasone.…”

Contrast-enhanced encephalopathy and massive cerebral edema after endovascular coiling of cerebral aneurysm. A case report

“…25 Studies have showed that a compromised BBB may lead to brain edema, resulting in the influx of proteins, electrolytes, as well as water across the anomalous perme- able cerebral vessels into the extracellular space. 26,27 The clinical presentation of CIEP often starts immediately after endovascular procedure with symptoms such as transient cortical blindness, depicted with unilateral or bilateral amaurosis fugax, normal pupillary light reflexes, and extraocular dysfunction. 3,11,[28][29][30] Also, patient present with headache, hemiparesis, aphasia, memory loss, as well as decrease in advanced mental functions like agraphia, loss of coordination, confusion, seizures, and coma.…”

“…3,11,13 Zhao et al reported patient who suffered irreversible fatal CIEP after DSA using iopamidol. 27 Autopsy involving 8 CIEP related decease patients revealed fatal cerebral edema due to contrast neurotoxicity. 27…”

“…27 Autopsy involving 8 CIEP related decease patients revealed fatal cerebral edema due to contrast neurotoxicity. 27…”

Evaluation of stability of deep venous thrombosis of the lower extremities using Doppler ultrasound

“…Currently, the primary method of diagnosing DVT is digital subtraction angiography, but the use of iodine contrast agents may lead to adverse reactions, such as allergies or kidney damage in patients. 14 Additionally, this method is invasive and its use is limited in some community hospitals. 15 In recent years, the technique of ultrasound has become increasingly advanced.…”