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.

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 Irreversible fatal contrast-induced encephalopathy: a case report

2019 ◽  
Author(s):  
Wei Zhao ◽  
Jinping Zhang ◽  
Yun Song ◽  
Lili Sun ◽  
Meimei Zheng ◽  
...  
Keyword(s):  
Contrast Agents ◽  
Cerebral Oedema ◽  
Cerebral Arteries ◽  
Clinical Status ◽  
Cortical Blindness ◽  
Deep Coma ◽  
Iodinated Contrast ◽  
Ionic Monomer ◽  
Cerebral Computed Tomography ◽  
Diagnostic Work

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.

scholarly journals Unusual Presentation of Transient Encephalopathy from Angiographic Contrast, After Neurointerventional Procedure.

2020 ◽  
pp. 1-4
Keyword(s):  
Contrast Media ◽  
Arteriovenous Fistula ◽  
Blood Brain Barrier ◽  
Dural Arteriovenous Fistula ◽  
Rare Complication ◽  
Cortical Blindness ◽  
Neurological Deficits ◽  
Rare Entity ◽  
Diagnostic Challenge ◽  
Spinal Dural Arteriovenous Fistula

Abstract Neurotoxicity from contrast media used in angiography is a rare complication from these procedures caused by disruption of the blood–brain-barrier (BBB), most of the time presenting as cortical blindness. The infrequency with which it is encountered makes it a diagnostic challenge. We present the case of a 64-year-old male who developed right hemianopsia, prosopagnosia and hallucinations after embolization of a cervical spinal dural arteriovenous fistula. The neurological deficits which appeared after the procedure, regressed completely after 48 hours. This rare entity should be kept in mind but diagnosed only when all other causes have been ruled out.

scholarly journals Irreversible fatal contrast-induced encephalopathy: a case report

2019 ◽  
Author(s):  
Wei Zhao ◽  
Jinping Zhang ◽  
Yun Song ◽  
Lili Sun ◽  
Meimei Zheng ◽  
...  
Keyword(s):  
Contrast Agents ◽  
Cerebral Oedema ◽  
Cerebral Arteries ◽  
Cortical Blindness ◽  
Iodinated Contrast ◽  
Middle Cerebral Arteries ◽  
Ionic Monomer ◽  
Cerebral Computed Tomography ◽  
Diagnostic Work ◽  
Work Up

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 paroxysmal buzzing of the brain. The cerebral magnetic resonance angiography (MRA) indicated the presence of arteriosclerosis of the 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. Although the patient was treated with anti-oedema drugs, her deterioration was continuous. She gradually became comatose and suffered irreversible fatal 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.

scholarly journals Cerebral Proliferative Angiopathy: Case Report

2018 ◽  
Vol 37 (02) ◽  
pp. 131-133 ◽  
Author(s):  
Luana Gatto ◽  
Rodrigo Brisson ◽  
Zeferino Demartini ◽  
Gelson Koppe ◽  
Carlos Rocha
Keyword(s):  
Case Report ◽  
Endovascular Procedures ◽  
Brain Parenchyma ◽  
Neurological Deficits ◽  
Motor Deficit ◽  
Brain Arteriovenous Malformation ◽  
Cerebral Vascular Disease ◽  
Functional Brain ◽  
History Of ◽  
Over Time

AbstractProliferative angiopathy (PA) is a rare cerebral vascular disease in which anomalous vessels continually recruit additional feeder arteries, amid a functional brain parenchyma. We report the case of a young woman with progressive history of headache, motor deficit, seizures and drowsiness. She received a misdiagnosis of brain arteriovenous malformation (AVM) and evolved with dysarthria and cognitive decline after an unsuccessful embolization performed at another institution. We opted for conservative treatment with periodic control by imaging tests. Proliferative angiopathy differs in natural history, prognosis, histopathology and treatment of the usual AVMs. Endovascular procedures aggravate the neurological deficits, which are usually progressive and tend to worsen over time.

scholarly journals Retrospective Analysis on Intraoperative Neuromonitoring (IOM) of Potential Nerve Injury in Scoliosis Correction Surgery

2021 ◽  
Vol 53 (1) ◽  
Author(s):  
Omat Rachmat ◽  
◽  
Dohar AL Tobing ◽  
Rr. Nur Fauziyah ◽  
Jenifer Kiem Aviani ◽  
...  
Keyword(s):  
Spinal Injury ◽  
Rare Complication ◽  
Intraoperative Neuromonitoring ◽  
Neurological Deficits ◽  
Neurological Injury ◽  
Central Hospital ◽  
Chi Square ◽  
Post Surgery ◽  
Scoliosis Correction ◽  
Correction Surgery

Iatrogenic spinal injury resulting in paraplegia or paraparesis after surgical correction of scoliosis deformity is a rare complication but is very detrimental to the patient. Intraoperative Neuromonitoring (IOM) has become the gold standard to monitor surgical procedures which has potential risks to damage the spinal cord. This study aimed to retrospectively analyze the role of IOM in predicting the severity and extent of neurological injury during and after spinal correction surgery in adult idiopathic scoliosis cases related to surgical variables. This was a retrospective cohort study conducted at Dr. Cipto Mangunkusumo National Central Hospital, Fatmawati Central Hospital, and dr. Drajat Prawiranegara General Hospital during the period of 20 March 2018 to 20 August 2019. The primary outcomes were intraoperative monitoring status and post-operative neurological deficits status. Confounder data on scoliosis correction degree, intraoperative hemorrhage, and type of anesthesia used during surgery were retrieved. Chi-Square statistic was used in the analysis. Out of the ninety three patients eligible for this study, twenty two patients was detected as positive in IOM assessment. Four of the patients were found to be positive for post-operative neuromuscular defect. Thereby it can be concluded that IOM procedure can effectively prevent neurological deficits post-surgery with 81.8% specificity and 95.7% sensitivity among thosepositively detected by IOM. Some of the factors that could potentially influence false positive IOM results such as anesthetic used; dosage and administration procedures; magnitude of the scoliosis correction angle; and amount of bleeding during surgery have to be carefully analyzed.

Ganglion cyst involvement of peripheral nerves

1997 ◽  
Vol 87 (3) ◽  
pp. 403-408 ◽  
Author(s):  
Kimberly S. Harbaugh ◽  
Robert L. Tiel ◽  
David G. Kline
Keyword(s):  
Peripheral Nerves ◽  
Ganglion Cyst ◽  
Medical Center ◽  
Case Reports ◽  
Motor Recovery ◽  
Neurological Deficits ◽  
Motor Deficit ◽  
Content Type ◽  
Ganglion Cysts ◽  
The Mean

✓ Despite their benign histological appearance and the current literature composed primarily of case reports with favorable outcomes, ganglion cysts involving peripheral nerves (GCPNs) can cause permanent neurological deficits. The authors present a 27-year Louisiana State University Medical Center (LSUMC) experience with the surgical management of GCPNs. From 1968 to 1995, 27 patients were surgically treated for 27 cysts that involved nerves at nine locations. Cysts of the peroneal nerve were the most common, comprising 52% of the cases. Motor deficit, pain, and sensory changes were present in 83%, 78%, and 48% of cases, respectively. A history of acute trauma was noted in 22%. The mean follow-up duration in these cases was 61 months. Motor recovery was good in only 58% of cases and was related to the severity of the preoperative motor deficit. Pain resolved or was significantly improved in 89% of cases. Five patients underwent nine procedures before referral to LSUMC for treatment of recurrence of their ganglion cysts. None of these patients suffered recurrence after undergoing surgery at LSUMC. However, four additional patients (17%) experienced a total of six recurrences after undergoing their initial procedure. The mean time to recurrence for the patient group as a whole was 16 months. On the basis of their experience, the authors conclude that GCPNs can behave in an aggressive fashion. Patients should be counseled preoperatively about the potential for limited motor recovery and a significant chance for recurrence.

Anti-N-methyl-D-aspartate receptor encephalitis and ovarian teratomas: is there any association?

2020 ◽  
Vol 19 (5) ◽  
pp. 124-131
Author(s):  
N.M. Podzolkova ◽  
◽  
V.V. Korennaya ◽  
O.S. Levin ◽  
E.E. Vasenina ◽  
...  
Keyword(s):  
Pathological Condition ◽  
Rare Complication ◽  
Autoimmune Encephalitis ◽  
Neurological Deficits ◽  
Ovarian Teratoma ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis ◽  
Life Threatening ◽  
Causal Treatment ◽  
Ovarian Teratomas

This article aims to explore the problem of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis and also describes our own experience in treating anti-NMDAR encephalitis in patients with ovarian teratomas. This pathological condition is a rare complication of cancer. Practicing gynecologists are often unfamiliar with it, although its consequences can be life-threatening. Early diagnosis and causal treatment, particularly teratoma removal, are critical for the outcome and can prevent death or the development of neurological deficits in patients. Key words: anti-NMDAR, autoimmune encephalitis, ovarian cysts, complications, ovarian teratoma, encephalitis, encephalitis in women

scholarly journals Postoperative Neurological Complications after a Cranial Surgery: A Multicentre Prospective Observational Study

2020 ◽  
Author(s):  
Ramesh J. Venkatapura ◽  
Surya K. Dubey ◽  
Nidhi Panda ◽  
Dhritiman Chakrabarti ◽  
Sudhir Venkataramaiah ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Tertiary Care ◽  
Neurological Complications ◽  
Vascular Pathology ◽  
Neurological Deficits ◽  
Motor Deficit ◽  
Fisher Exact Test ◽  
Chi Square ◽  
Exact Test ◽  
Cranial Surgery

Abstract Background  Cranial surgery is associated with multiple postoperative complications varying from simple nausea and vomiting to devastating complications such as stroke and death. This multicentre collaborative effort was envisioned to collect observational data regarding postoperative complications in cranial surgeries among the Indian population. The aim of this study was to describe the postoperative neurological complications occurring within the first 24 hours after surgery and to identify the predictive factors. Methods Data was collected from three participating tertiary care academic institutions. The study was prospective, observational, multicentre design with data collected over a period of two months or 100 cases, whichever is earlier, from each participating institute. A predesigned Microsoft excel sheet was distributed among all three centers to maintain uniformity. All patients aged 18 years and above of both sexes undergoing elective or emergency craniotomies were included in the study. The postoperative neurological complications (within 24 hours) assessed were: (1) Neurological deficit (ND) defined as new focal neurological motor deficit relative to preoperative status. (2) Sensorium deterioration (SD) defined as reduction in Glasgow coma score (GCS) by 2 or more points compared with preoperative GCS. (4) Postoperative seizures (SZs) defined as any seizure activity. All possible variables associated with the above neurological complications were tested using Chi-square/Fisher exact test or Mann–Whitney U test. The predictors, which were statistically significant at p < 0.2, were entered into a multiple logistic regression model. Alpha error of 5% was taken as significant. Results Data from three institutions was collected with a total of 279 cases. In total, there were 53 (19%) neurological complications. There were 28 patients with new postoperative NDs (10.04%), 24 patients had SD (8.6%), and 17 patients had seizures (6.1%). Neurological deficits were significantly less in institution 2. Diagnosis of traumatic brain injury (TBI) was associated with very low risk of ND, and vascular pathology was associated with higher chance of a ND. The duration of anesthesia was found to be significantly predictive of SD (OR/CI = 1.01 / 1–1.02). None of the factors were predictive of PS. Conclusion The incidences of postoperative ND, SD and postoperative seizures were 10%, 8.6%, and 6.1%, respectively. Studies with a much larger sample size are required for a better and detailed analysis of these complications.

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