Low-dose Contrast-induced Encephalopathy During Diagnostic Cerebral Angiography

Abstract

Contrast-induced encephalopathy (CIE) is a rare complication of contrast agent use. We herein report a case of acute lacunar infarction in a 70-year-old woman. During diagnostic cerebral angiography for asymptomatic common carotid stenosis, she experienced transient drowsiness. After angiography, generalized tonic-clonic seizures occurred in her left arm and leg, with eye deviation to the left. The patient was diagnosed with CIE due to the acute onset of symptoms during angiography and characteristic computed tomography findings of high-density signaling in the cortex. Our findings suggest that it is important to pay close attention to acute neurological symptoms during and immediately after examinations, even with small amounts of contrast agents.

Case Report: A 62-Year-Old Woman With Contrast-Induced Encephalopathy Caused by Embolization of Intracranial Aneurysm

“…The incidence of CIE seems to be lower in recent years due to the increased use of nonionic contrast agents. Though neurological status usually occurs self-limiting over a period of days ( 3 ), there are persistent neurological deficits and irreversible fatal cerebral edema cases reported ( 4 , 5 ). Therefore, CIE should be kept in mind as a complication of angiography and supportive therapy should be initiated as soon as possible.…”

“…The mechanism and cause of CIE are associated with the disruption of the blood-brain barrier (BBB). Contrast agents can damage the BBB and facilitate its own entry into the brain, which is considered to be one of the mechanisms of CIE ( 4 ). Studies have been indicated that the risk factors of CIE included hypertension, renal disorder, acute cerebral infarction, the low temperature of contrast media, and endovascular surgery requiring a higher dose of contrast agents ( 6 ).…”

Fully Reversible Contrast-Induced Encephalopathy Mimicking Stroke after Flow Diverter Treatment of Carotid Cave Aneurysm

“…It has been suggested that higher doses and lower temperatures of contrast media, kidney disorders, arterial hypertension, and acute cerebral infarction are risk factors for CIE. 9 Higher contrast dose and prior stroke were corroborated as risk factors in a recent meta-analysis. 10 However, lower doses of contrast agent have also been associated with CIE. 11 The doses reported in the literature varied widely depending on procedure type with volumes as low as 24 mL in a cerebral angiography case 6 and as high as 360 mL in a spinal angiography case. 12 Our patient received a total volume of contrast of 125 mL.…”

Contrast-induced encephalopathy and permanent neurological deficit following cerebral angiography: A case report and review of the literature

“…However, four of them were excluded because it was defined as allergic reactions, vasospasm, and posterior reversible encephalopathy syndrome, and complete data were not available in the other six papers. Finally, we accurately summarized 30 papers ( Leong and Fanning, 2012 ; Yan and Ramanathan, 2013 ; Kocabay et al, 2014 ; Nagamine et al, 2014 ; Hamra et al, 2017 ; Park et al, 2017 ; Spina et al, 2017 ; Dattani et al, 2018 ; Heemelaar et al, 2018 ; Hirata et al, 2018 ; Kahyaoğlu et al, 2018 ; Tong et al, 2018 ; Renault and Rouchet, 2019 ; Riahi et al, 2019 ; Şimşek et al, 2019 ; Zhao et al, 2019 , 2021 ; Fernando et al, 2020 ; Harada et al, 2020 ; Lei et al, 2020 ; Liu et al, 2020 ; Andone et al, 2021 ; Cristaldi et al, 2021 ; García-Pérez et al, 2021 ; Kamimura et al, 2021 ; Li et al, 2021 ; Vigano et al, 2021 ; Yao et al, 2021 ; Zhang et al, 2021 ; Rashid et al, 2022 ). A total of 127 patients were enrolled.…”