Neurotoxicity of Water-Soluble Contrast Media

Nonionic Contrast Neurotoxicity after Coronary Angiography Mimicking Subarachnoid Hemorrhage

“…This was also consistent with voxel densities reaching as much as 96 Hounsfield units, clearly exceeding blood density ranging from 40 to 60 units [5]. CM enrichment in the CSF is a consequence of CMtoxic blood-brain/blood-CSF barrier disruption followed by CM extravasation [1]. A subacute stroke as the source of a disturbed blood-brain barrier could be excluded by the MRI findings with a normal diffusion-weighted image of the same anatomical region which displayed contrast enhancement in the sulci in the CCT Although the administration of 500 ml Iomeron 350 was just below the maximum recommended dose for coronary angiography as indicated by the manufacturer, it may be regarded as a relative overdosage in our patient with underlying chronic renal function impairment.…”

“…The incidence of neurotoxic events due to intravascular application of iodinated x-ray contrast media (CM) has decreased markedly since the introduction of nonionic CM [1]. Severe neurotoxic complications are accompanied by disruption of the blood-brain barrier and CM extravasation [1][2][3][4][5][6].…”

“…Severe neurotoxic complications are accompanied by disruption of the blood-brain barrier and CM extravasation [1][2][3][4][5][6]. Coronary angiography involving only nonionic CM has been reported to cause transient cortical blindness, confusion and amnesia, but no focal deficits [3,4], whereas coronary angiography involving ionic CM was followed by more severe complications including seizures, motor and speech deficits [5,6].…”

Contrast-Induced Neurotoxicity and Selective Cortical Injury

“…Our patient had a cortical DWI signal in ACA-MCA and MCA-PCA watershed territories suggesting that a slower washout of contrast medium may have contributed to its toxic effects. Once contrast medium permeates the brain, it can cause cortical dysfunction by increasing neuronal excitability [4] . Iohexol, which contains edetate calcium disodium, may further exacerbate excitotoxicity by activation of N-methyl-D -aspartate receptors.…”

Fatal anaphylactoid reaction following ioversol administration

“…Moreover, calcium-channel blockers can be considered for their positive effects on renal haemodynamics and their cytoprotective effects on renal cells. Furthermore, pre-heating of the contrast fluid before administration decreases its viscosity, reducing side-effects as well [7].…”