Contrast-Induced Encephalopathy following Coronary Angiography with No Radiological Features: A Case Report and Literature Review

Cardiology ◽  
2018 ◽  
Vol 139 (3) ◽  
pp. 197-201 ◽  
Author(s):  
Abhishek Dattani ◽  
Laura Au ◽  
Kok Hoon Tay ◽  
Patrick Davey
Keyword(s):  
Coronary Angiography ◽  
Cerebral Oedema ◽  
Rare Complication ◽  
Neurological Deficits ◽  
Review Of The Literature ◽  
Radiological Features ◽  
Iodinated Contrast ◽  
Iodinated Contrast Agent ◽  
Contrast Ct ◽  
Supportive Management

Contrast-induced encephalopathy (CIE) following coronary angiography (CAG) is a very rare complication. Radiological signs such as cerebral oedema and cortical enhancement are of great importance in the diagnosis. We report a case of probable CIE in a 76-year-old gentleman following a normal diagnostic CAG that involved 120 mL of the iodinated contrast agent iohexol (Omnipaque 300). At 90 min postprocedure he became acutely confused with a normal non-contrast CT of the head. After 9 days of conservative treatment, the patient recovered spontaneously with no neurological deficits. This case and a review of the literature highlights that contrast-induced neurotoxicity may not always present with the typical radiological signs that are described in association with CIE. Given the excellent prognosis with supportive management only, interventional cardiologists should be well aware of this condition despite the absence of radiological features.

scholarly journals Persistent Neurological Deficit from Iodinated Contrast Encephalopathy following Intracranial Aneurysm Coiling

2012 ◽  
Vol 18 (1) ◽  
pp. 33-41 ◽  
Author(s):  
S. Leong ◽  
N.F. Fanning
Keyword(s):  
Neuronal Excitability ◽  
Cerebral Oedema ◽  
Rare Complication ◽  
Harmful Effect ◽  
Cortical Blindness ◽  
Neurological Deficits ◽  
Motor Deficit ◽  
Clinical Effects ◽  
Iodinated Contrast ◽  
Aneurysm Coiling

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.

scholarly journals Contrast-Induced Encephalopathy after Cerebral Angiogram: A Case Series and Review of Literature

2021 ◽  
pp. 405-413
Author(s):  
Cecelia Allison ◽  
Vaibhav Sharma ◽  
Jason Park ◽  
Clemens M. Schirmer ◽  
Ramin Zand
Keyword(s):  
Rare Complication ◽  
General Pattern ◽  
Treatment Protocol ◽  
Case Series ◽  
Altered Mental Status ◽  
Cortical Blindness ◽  
Neurological Deficits ◽  
Cerebral Angiogram ◽  
Iodinated Contrast Medium ◽  
Iodinated Contrast

Contrast-induced encephalopathy (CIE) is a rare complication that arises from exposure to iodinated contrast medium and can result in a range of symptoms, including cortical blindness, aphasia, focal neurological deficits, and altered mental status. We present 4 individual cases of CIE who presented with stroke-mimic symptoms following surgery with localized iodixanol or ioversol injection. We outline a clinical timeline of all patients, showing that CIE follows a general pattern of delayed onset, worsening symptomology, and ultimately full recovery. All patients received IV hydration, corticosteroids, or both as part of their treatment protocol.

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

2021 ◽  
Vol 8 ◽  
Author(s):  
Ying Zhang ◽  
Ming Zhou ◽  
Dong Wang ◽  
Tao Liu ◽  
Pengfei Chang ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Rare Complication ◽  
Symptomatic Treatment ◽  
Neurological Deficits ◽  
Right Cerebral Hemisphere ◽  
The Right ◽  
Occipital Lobes ◽  
Supportive Management ◽  
The Brain ◽  
Benign Course

Contrast-induced encephalopathy (CIE) is a rare complication of endovascular treatment and is extensively reported as a transient and reversible phenomenon. This report describes a 62-year-old woman for embolization of an internal carotid artery (ICA) aneurysm. The operation was successful, but postoperation the patient suffered unconsciousness, blindness, hemiplegia, ophthalmoplegia, fever, and seizures. CT of the brain without the contrast showed widespread edema in the right cerebral hemisphere, which is involved in the frontal, parietal, temporal, and occipital lobes. She was diagnosed with CIE in time and treated with supportive management as soon as possible, and fortunately, the patient improved a benign course and was discharged without any neurological deficits. This study emphasizes the prevention of the CIE and the importance of early diagnosis and symptomatic treatment.

scholarly journals Delayed Tension Pneumocephalus following Gunshot Wound to the Head: A Case Report and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Arthur Wang ◽  
Elena Solli ◽  
Nathan Carberry ◽  
Virany Hillard ◽  
Adesh Tandon
Keyword(s):  
Gunshot Wound ◽  
Rare Complication ◽  
Mass Effect ◽  
Neurological Deficits ◽  
Neurosurgical Procedures ◽  
Review Of The Literature ◽  
Increased Intracranial Pressure ◽  
Tension Pneumocephalus ◽  
Postnasal Drip ◽  
The Right

Tension pneumocephalus is a rare complication of head trauma and neurosurgical procedures, amongst other causes. It is defined by the combination of intracranial air, increased intracranial pressure, and mass effect. Although it often presents soon after surgery, it can also rarely present in a delayed fashion. We present a case of delayed tension pneumocephalus, occurring approximately 16 weeks after bifrontal craniectomy for a self-inflicted gunshot wound. Following a month of rhinorrhea, postnasal drip, and cough, the patient presented with a sensation of expansion in the area of the right forehead. As tension pneumocephalus is an emergency that can be fatal, this patient was treated expediently and avoided severe neurological deficits. The case recounted here is important as a demonstrative example that tension pneumocephalus does not always follow a defined course immediately after trauma or neurosurgery but rather can develop insidiously without obvious signs.

Physiology of Intraluminal Administration of Carbon Dioxide as a Contrast Medium

2020 ◽  
Vol 25 (44) ◽  
pp. 4656-4661 ◽  
Author(s):  
Nikolaos Patelis ◽  
Mikes Doulaptsis ◽  
Stylianos Kykalos ◽  
Eleftherios Spartalis ◽  
Anastasios Maskanakis ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Contrast Agent ◽  
20Th Century ◽  
English Literature ◽  
Human Organism ◽  
Digital Subtraction ◽  
Extensive Search ◽  
Iodinated Contrast ◽  
Iodinated Contrast Agent ◽  
Carbon Dioxide Co2

Background: Carbon dioxide (CO2) exists in nature around us. In the middle of the 20th century, the intraluminal injection of CO2 demonstrated similar results to those of Digital Subtraction Angiography (DSA) with an iodinated contrast agent (ICA). Since then, the technology behind CO2 DSA has developed significantly. Objective: The aim of this study is to inform physicians about the unique properties of CO2 and its physiology after intraluminal injection. Methods: An extensive search for English literature on the properties of CO2 and the physiology of intraluminal administration was conducted using Pubmed. Results: There is sufficient literature on the properties of CO2 and the physiology of CO2 DSA. A review of this literature explains what happens to the human organism after the injection of CO2. Conclusions: There is enough evidence that CO2 DSA is both effective, diagnostic and safe, but the properties of CO2 should be taken under consideration as complications occur, although rarely.

scholarly journals Indications and outcomes of enterovesical and colovesical fistulas: systematic review of the literature and meta-analysis of prevalence

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stefano Granieri ◽  
Francesco Sessa ◽  
Alessandro Bonomi ◽  
Sissi Paleino ◽  
Federica Bruno ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Symptoms ◽  
Rare Complication ◽  
Meta Analysis ◽  
Treatment Options ◽  
Palliative Surgery ◽  
Review Of The Literature ◽  
Colovesical Fistula ◽  
Level Of Evidence ◽  
Meta Analyses

Abstract Background Entero-colovesical fistula is a rare complication of various benign and malignant diseases. The diagnosis is prominently based on clinical symptoms; imaging studies are necessary not only to confirm the presence of the fistula, but more importantly to demonstrate the extent and the nature of the fistula. There is still a lack of consensus regarding the if, when and how to repair the fistula. The aim of the study is to review the different surgical treatment options, focus on surgical indications, and explore cumulative recurrence, morbidity, and mortality rates of entero-vesical and colo-vesical fistula patients. Methods A systematic review of the literature was conducted according to PRISMA guidelines. Random effects meta-analyses of proportions were developed to assess primary and secondary endpoints. I2 statistic and Cochran’s Q test were computed to assess inter-studies’ heterogeneity. Results Twenty-two studies were included in the analysis with a total of 861 patients. Meta-analyses of proportions pointed out 5, 22.2, and 4.9% rates for recurrence, complications, and mortality respectively. A single-stage procedure was performed in 75.5% of the cases, whereas a multi-stage operation in 15.5% of patients. Palliative surgery was performed in 6.2% of the cases. In 2.3% of the cases, the surgical procedure was not specified. Simple and advanced repair of the bladder was performed in 84.3% and 15.6% of the cases respectively. Conclusions Although burdened by a non-negligible rate of complications, surgical repair of entero-colovesical fistula leads to excellent results in terms of primary healing. Our review offers opportunities for significant further research in this field. Level of Evidence Level III according to ELIS (SR/MA with up to two negative criteria).

scholarly journals Coronary Flow and Reserve by Enhanced Transthoracic Doppler Trumps Coronary Anatomy by Computed Tomography in Assessing Coronary Artery Stenosis

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 245
Author(s):  
Carlo Caiati ◽  
Arnaldo Scardapane ◽  
Fortunato Iacovelli ◽  
Paolo Pollice ◽  
Teresa Immacolata Achille ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Flow Velocity ◽  
Coronary Flow ◽  
Invasive Coronary Angiography ◽  
Coronary Anatomy ◽  
Color Mapping ◽  
Flow Reserve ◽  
Mild Stenosis ◽  
Iodinated Contrast

We report the case of a 71-year-old patient with many risk factors for coronary atherosclerosis, who underwent computed coronary angiography (CTA), in accordance with the guidelines, for recent onset atypical chest pain. CTA revealed critical (>50% lumen diameter narrowing) stenosis of the proximal anterior descending coronary, and the patient was scheduled for invasive coronary angiography (ICA). Before ICA he underwent enhanced transthoracic echo-Doppler (E-Doppler TTE) for coronary flow detection by color-guided pulsed-wave Doppler recording of the left main (LMCA) and whole left anterior descending coronary artery (LAD,) along with coronary flow reserve (CFR) in the distal LAD calculated as the ratio, of peak flow velocity during i.v. adenosine (140 mcg/Kg/m) to resting flow velocity. E-Doppler TTE mapping revealed only mild stenosis (28% area narrowing) of the mid LAD and a CFR of 3.20, in perfect agreement with the color mapping showing no flow limiting stenosis in the LMCA and LAD. ICA revealed only a very mild stenosis in the mid LAD and mild atherosclerosis in the other coronaries (intimal irregularities). Thus, coronary stenosis was better predicted by E-Doppler TTE than by CTA. Coronary flow and reserve as assessed by E-Doppler TTE trumps coronary anatomy as assessed by CTA, without exposing the patient to harmful radiation and iodinated contrast medium.

Delayed leukoencephalopathy from suspected polymer embolism after neuroendovascular procedures

2021 ◽  
pp. 197140092110291
Author(s):  
Thomas Mellemkjær ◽  
Ronil V Chandra ◽  
Lasse Speiser ◽  
Benedicte P Ulhøi ◽  
Claus Z Simonsen
Keyword(s):  
Polymer Material ◽  
Endovascular Procedures ◽  
Rare Complication ◽  
Diagnostic Process ◽  
Line Treatment ◽  
Review Of The Literature ◽  
First Line ◽  
Stroke Treatment ◽  
Oral Glucocorticoids ◽  
First Line Treatment

As the neurointervention field grows, a new side effect emerges. Delayed leukoencephalopathy (DL) is believed to be an inflammatory or allergic reaction to polymer material that is shed from catheters during endovascular procedures. We present four cases of DL after aneurysm treatment in two patients, endovascular stroke treatment and diagnostic arteriography. We present our diagnostic process, including biopsy results in two patients, our anti-inflammatory treatment and outcomes together with a review of the literature. In our series, prognosis was variable with ongoing seizures in two patients. Our literature review reveals that asymptomatic shedding of polymer material is common, occurring in a third of endovascular stroke procedures, whereas symptomatic DL occurs in <0.5% of therapeutic neuroendovascular procedures. Clinicians should be aware of this rare complication, and oral glucocorticoids seem to be a reasonable first-line treatment strategy.

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