Persistent Neurological Deficit from Iodinated Contrast Encephalopathy following Intracranial Aneurysm Coiling

Abstract

<jats:p> Neurotoxicity from iodinated contrast agents is a known but rare complication of angiography and neurovascular intervention. Neurotoxicity results from contrast penetrating the blood-brain barrier with resultant cerebral oedema and altered neuronal excitability. Clinical effects include encephalopathy, seizures, cortical blindness and focal neurological deficits. Contrast induced encephalopathy is extensively reported as a transient and reversible phenomenon. We describe a patient with a persistent motor deficit due to an encephalopathy from iodinated contrast media administered during cerebral aneurysm coiling. This observation and a review of the literature highlights that contrast-induced encephalopathy may not always have a benign outcome and can cause permanent deficits. This potential harmful effect should be recognised by the angiographer and the interventionalist. </jats:p>

Confirmation of a Diagnosis by CSF Analysis in a Case of Symptomatic Contrast-induced Encephalopathy with an Onset Immediately after Coil Embolization of an Unruptured Cerebral Aneurysm

“…Since symptoms may persist or appear in the subacute period, although very rarely, 16,17) attention to contrast-induced encephalopathy is considered necessary as a complication of intracranial endovascular treatment.…”

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

“…Mechanisms by which contrast agent causes neurotoxicity should be discussed (7). Under normal conditions, intravenous contrast material does not diffuse in the BBB (7). But when BBB is disrupted, over dose contrast agent is applied or contrast agent is applied intra-arterially, transfer of contrast material increases (7).…”

“…In addition, it should be kept in mind that contrast matters used in various ways (intravenous, intra-arterial, intrathecal) in different radiological imaging methods can result in neurotoxicity. Mechanisms by which contrast agent causes neurotoxicity should be discussed (7). Under normal conditions, intravenous contrast material does not diffuse in the BBB (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.…”

Decreased Infarct Volume and Intracranial Hemorrhage Associated with Intra-Arterial Nonionic Iso-Osmolar Contrast Material in an MCA Occlusion/Reperfusion Model

“…24 There is conflicting evidence regarding increased neurotoxicity once the IRCM has crossed the BBB in animals and humans. 17,[25][26][27][28][29] Heinrich et al 30 compared the direct cytotoxic effects of dimeric iso-osmolar and monomeric isoosmolar IRCM on renal tubular cells in vitro and found that dimeric IRCM have stronger direct cytotoxic effects, postulating a mechanism independent from osmolarity. 30 Molecular chemotoxicity, related to the chemical structure of the molecule, decreases as the number of carboxyl groups decreases and the number of hydroxyl groups increases.…”