Rapid contrast-induced encephalopathy after a small dose of contrast agent: illustrative case

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Zhouyang Zhao ◽  
Lijin Huang ◽  
Jinhua Chen ◽  
Hongshen Zhu
Keyword(s):  
Carotid Artery ◽  
Contrast Agent ◽  
Cerebral Angiography ◽  
Small Dose ◽  
Rare Complication ◽  
Brain Magnetic Resonance Imaging ◽  
Neurological Status ◽  
Illustrative Case ◽  
Disturbance Of Consciousness ◽  
Nonionic Contrast Agent

BACKGROUNDContrast-induced encephalopathy is a rare complication of cerebral angiography with only few cases reported to date. This paper reports on contrast-induced encephalopathy mimicking meningoencephalitis following cerebral angiography with iopromide, a subhypertonic nonionic contrast agent.OBSERVATIONSA 50-year-old woman underwent cerebral angiography for assessment of recurrent nasopharyngeal carcinoma with invasion of internal carotid artery. The patient experienced symptoms including a disturbance of consciousness, seizures, frequent blinking, and stiffness in the extremities immediately after angiography of the left common carotid artery using iopromide (4 ml/s, total 6 ml). Computed tomography scans of the brain showed no obvious abnormalities, whereas brain magnetic resonance imaging showed swelling of the left cerebral cortex without signs of ischemia or hemorrhage. The patient was treated with intravenous rehydration, mannitol dehydration, and other supportive treatment. With this treatment, neurological status progressively improved, with complete resolution of symptoms at day 10.LESSONSThis observation highlights that even a small dose of subhypertonic nonionic contrast agent can rapidly induce contrast encephalopathy.

scholarly journals Sinking skin flap syndrome in a patient with bone resorption after cranioplasty and ventriculoperitoneal shunt placement: illustrative case

2021 ◽  
Vol 2 (11) ◽  
Author(s):  
Camryn R. Rohringer ◽  
Taryn J. Rohringer ◽  
Sumit Jhas ◽  
Mehdi Shahideh
Keyword(s):  
Bone Resorption ◽  
Decompressive Craniectomy ◽  
Rare Complication ◽  
Skin Flap ◽  
Mass Effect ◽  
Neurological Status ◽  
Bone Flap ◽  
Illustrative Case ◽  
Vp Shunt

BACKGROUND Sinking skin flap syndrome (SSFS) is an uncommon complication that can follow decompressive craniectomy. Even less common is the development of SSFS following bone resorption after cranioplasty with exacerbation by a ventriculoperitoneal (VP) shunt. OBSERVATIONS A 56-year-old male sustained a severe traumatic brain injury and subsequently underwent an emergent decompressive craniectomy. After craniectomy, a cranioplasty was performed, and a VP shunt was placed. The patient returned to the emergency department 5 years later with left-sided hemiplegia and seizures. His clinical presentation was attributed to complete bone flap resorption (BFR) complicated by SSFS likely exacerbated by his VP shunt and the resultant mass effect on the underlying brain parenchyma. The patient underwent surgical intervention via synthetic bone flap replacement. Within 6 days, he recovered to his baseline neurological status. LESSONS SSFS after complete BFR is a rare complication following cranioplasty. To the authors’ knowledge, having a VP shunt in situ to exacerbate the clinical picture has yet to be reported in the literature. In addition to presenting the case, the authors also describe an effective treatment strategy of decompressing the brain and elevating the scalp flap while addressing the redundant tissue, then using a synthetic mesh to reconstruct the calvarial defect while keeping the shunt in situ.

Pseudoaneurysm of the left internal carotid artery following tonsillectomy

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 491-494 ◽  
Author(s):  
Vávrová ◽  
Slezácek ◽  
Vávra ◽  
Karlová ◽  
Procházka
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Rare Complication ◽  
Left Internal Carotid Artery ◽  
Acute Tonsillitis ◽  
Artery Pseudoaneurysm ◽  
Complete Occlusion ◽  
Endovascular Approach ◽  
Deep Neck Infections

Internal carotid artery pseudoaneurysm is a rare complication of deep neck infections. The authors report the case of a 17-year-old male who presented to the Department of Otorhinolaryngology with an acute tonsillitis requiring tonsillectomy. Four weeks after the surgery the patient was readmitted because of progressive swallowing, trismus, and worsening headache. Computed tomography revealed a pseudoaneurysm of the left internal carotid artery in the extracranial segment. A bare Wallstent was implanted primarily and a complete occlusion of the pseudoaneurysm was achieved. The endovascular approach is a quick and safe method for the treatment of a pseudoaneurysm of the internal carotid artery.

Nonketotic Hyperglycemic Chorea in a 10-Year-Old Asian Boy with Diabetes Mellitus

2020 ◽  
Author(s):  
Julia Marian ◽  
Firdous Rizvi ◽  
Lily Q. Lew
Keyword(s):  
Diabetes Mellitus ◽  
Parietal Lobe ◽  
Rare Complication ◽  
Brain Magnetic Resonance Imaging ◽  
Food Allergies ◽  
Developmental Venous Anomaly ◽  
Venous Anomaly ◽  
Resonance Imaging ◽  
Focal Lesions

AbstractNonketotic hyperglycemic chorea-ballism (NKHCB), also known as diabetic striato-pathy (DS) by some, is a rare complication of diabetes mellitus and uncommon in children. We report a case of a 10 11/12-year-old boy of Asian descent with uncontrolled type 1 diabetes mellitus (T1DM), Hashimoto's thyroiditis, and multiple food allergies presenting with bilateral chorea-ballism. His brain magnetic resonance imaging revealed developmental venous anomaly in right parietal lobe and right cerebellum, no focal lesions or abnormal enhancements. Choreiform movements resolved with correction of hyperglycemia. Children and adolescents with a movement disorder should be evaluated for diabetes mellitus, especially with increasing prevalence and insidious nature of T2DM associated with obesity.

Multiple Cerebral Aneurysm - Case Report

2014 ◽  
Vol 21 (3) ◽  
pp. 279-282 ◽  
Author(s):  
C. Kakucs ◽  
I. St. Florian
Keyword(s):  
Case Report ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Ct Scan ◽  
Cerebral Aneurysm ◽  
Internal Carotid ◽  
Neurological Status ◽  
Posterior Communicating Artery ◽  
Nuchal Rigidity ◽  
Angio Ct

Abstract This 41-years-old female presented with somnolence, confusion and nuchal rigidity. Preoperative angio-CT scan showed two aneurysm located on both internal carotid artery (ICA) at the site of posterior communicating artery (PComA). During surgery we discovered another dilatation on the origin of left ophtalmic artery that proves to be an infundibullum. We clipped the two communicating posterior aneurysm from the left side and the ophtalmic infundibullum was wrapped. Seven days after surgery the neurological status was improved and she was transferred to the Neurological department.

Long-term stability of fusiform dilatation of the internal carotid artery following surgery adjacent to the circle of Willis: report of 2 cases

2020 ◽  
pp. 1-4
Author(s):  
Madeline B. Karsten ◽  
R. Michael Scott
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Arachnoid Cyst ◽  
Pediatric Patients ◽  
Internal Carotid ◽  
Imaging Finding ◽  
Neurological Status ◽  
Suprasellar Region

Fusiform dilatation of the internal carotid artery (FDCA) is a known postoperative imaging finding after craniopharyngioma resection. FDCA has also been reported following surgery for other lesions in the suprasellar region in pediatric patients and is thought to be due to trauma to the internal carotid artery (ICA) wall during tumor dissection. Here, the authors report 2 cases of pediatric patients with FDCA. Case 1 is a patient in whom FDCA was visualized on follow-up scans after total resection of a craniopharyngioma; this patient’s subsequent scans and neurological status remained stable throughout a 20-year follow-up period. In case 2, FDCA appeared after resection and fenestration of a giant arachnoid cyst in a 3-year-old child, with 6 years of stable subsequent follow-up, an imaging finding that to the authors’ knowledge has not previously been reported following surgery for arachnoid cyst fenestration. These cases demonstrate that surgery involving dissection adjacent to the carotid artery wall in pediatric patients may lead to the development of FDCA. On very long-term follow-up, this imaging finding rarely changes and virtually all patients remain asymptomatic. Neurointerventional treatment of FDCA in the absence of symptoms or significant late enlargement of the arterial ectasia does not appear to be indicated.

A rare complication with Edwards Sapien: Aortic valve embolization in TAVI

Vascular ◽  
2014 ◽  
Vol 23 (1) ◽  
pp. 102-104 ◽  
Author(s):  
Hüseyin Ayhan ◽  
Tahir Durmaz ◽  
Telat Keleş ◽  
Hacı Ahmet Kasapkara ◽  
Kemal Eşref Erdoğan ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Carotid Artery ◽  
Transcatheter Aortic Valve Implantation ◽  
Common Carotid Artery ◽  
Rare Complication ◽  
Transcatheter Aortic Valve ◽  
Truncus Brachiocephalicus ◽  
Edwards Sapien ◽  
Aortic Valve Implantation ◽  
Valve Implantation

One of the problems is valve embolization at the time of transcatheter aortic valve implantation, which is a rare but serious complication. In this case, we have shown balloon expandable aortic valve embolization TAVI which is a rare complication and we managed with second valve without surgery. Although there is not enough experience in the literature, embolized valve was re-positioned in the arch aorta between truncus brachiocephalicus and left common carotid artery.

scholarly journals Effect of aortic arch type on technical indicators in patients undergoing carotid artery stenting

2018 ◽  
Vol 47 (2) ◽  
pp. 682-688 ◽  
Author(s):  
Songhe Shen ◽  
Xiongjing Jiang ◽  
Hui Dong ◽  
Meng Peng ◽  
Zhixue Wang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Contrast Agent ◽  
Aortic Arch ◽  
Carotid Artery Stenting ◽  
Influential Factor ◽  
Fluoroscopy Time ◽  
Type I ◽  
Technical Indicators ◽  
Type Iii ◽  
Guiding Catheter

Objective This study was performed to explore the effect of the aortic arch type on technical indicators in patients undergoing carotid artery stenting (CAS). Methods The data of 224 consecutive patients who underwent unilateral CAS from January 2011 to December 2012 were retrospectively analyzed. The requirement for placement of the guiding catheter into the common carotid artery with assistance of an angiographic catheter, fluoroscopy time, contrast agent dose, and adverse events were recorded. Results The fluoroscopy time was significantly longer and the contrast agent dose was significantly higher in patients with Type III than Type I and II arches. Significantly more patients with Type III than Type I and II arches required placement of the guiding catheter with assistance of an angiographic catheter (46.2% vs. 15.0%, respectively). The procedural success rate was significantly lower in patients with Type III than Type I and II arches (96.2% vs. 100.0%, respectively). The incidence of death, myocardial infarction, and all types of stroke was significantly higher in patients with Type III than Type I and II arches (7.7% vs. 1.7%, respectively). Conclusions The aortic arch type is an important influential factor in CAS. Type III arches are associated with more difficulties and complications.

scholarly journals Clinical superiority of a new nonionic contrast agent (iopamidol) for cardiac angiography

1985 ◽  
Vol 5 (2) ◽  
pp. 250-258 ◽  
Author(s):  
Edward W. Gertz ◽  
Judith A. Wisneski ◽  
David Chiu ◽  
John R. Akin ◽  
Charlotte Hu
Keyword(s):  
Contrast Agent ◽  
Cardiac Angiography ◽  
Nonionic Contrast Agent

Interindividual variability of arterial impulse response to intravenous injection of nonionic contrast agent (Iohexol) in DCE-CT study

2009 ◽  
Vol 36 (10) ◽  
pp. 4791-4802 ◽  
Author(s):  
S. M. Kim ◽  
M. A. Haider ◽  
M. Milosevic ◽  
I. W. T. Yeung
Keyword(s):  
Contrast Agent ◽  
Impulse Response ◽  
Intravenous Injection ◽  
Interindividual Variability ◽  
Nonionic Contrast Agent

scholarly journals Decompressive craniectomy for internal carotid artery and middle carotid artery infarctions: a long-term comparative outcome study

2021 ◽  
Vol 51 (1) ◽  
pp. E10
Author(s):  
Jia Xu Lim ◽  
Srujana Venkata Vedicherla ◽  
Shu Kiat Sukit Chan ◽  
Nishal Kishinchand Primalani ◽  
Audrey J. L. Tan ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Decompressive Craniectomy ◽  
Functional Outcomes ◽  
Internal Carotid ◽  
Neurological Status ◽  
Inpatient Mortality ◽  
Stroke Treatment ◽  
Significant Difference ◽  
Cox Proportional Hazard Regression

OBJECTIVE Malignant internal carotid artery (ICA) infarction is an entirely different disease entity when compared with middle cerebral artery (MCA) infarction. Because of an increased area of infarction, it is assumed to have a poorer prognosis; however, this has never been adequately investigated. Decompressive craniectomy (DC) for malignant MCA infarction has been shown to improve mortality rates in several randomized controlled trials. Conversely, aggressive surgical decompression for ICA infarction has not been recommended. The authors sought to compare the functional outcomes and survival between patients with ICA infarctions and those with MCA infarctions after DC in the largest series to date to investigate this assumption. METHODS A multicenter retrospective review of 154 consecutive DCs for large territory cerebral infarctions performed from 2005 to 2020 were analyzed. Patients were divided into ICA and MCA groups depending on the territory of infarction. Variables, including age, sex, medical comorbidities, laterality of the infarction, preoperative neurological status, primary stroke treatment, and the time from stroke onset to DC, were recorded. Univariable and multivariable analyses were performed for the clinical exposures for functional outcomes (modified Rankin Scale [mRS] score) on discharge and at the 1- and 6-month follow-ups, and for mortality, both inpatient and at the 1-year follow-up. A favorable mRS score was defined as 0–2. RESULTS There were 67 patients (43.5%) and 87 patients (56.5%) in the ICA and MCA groups, respectively. Univariable analysis showed that the ICA group had a comparably favorable mRS (OR 0.15 [95% CI 0.18–1.21], p = 0.077). Inpatient mortality (OR 1.79 [95% CI 0.79–4.03], p = 0.16) and 1-year mortality (OR 2.07 [95% CI 0.98–4.37], p = 0.054) were comparable between the groups. After adjustment, a favorable mRS score at 6 months (OR 0.17 [95% CI 0.018–1.59], p = 0.12), inpatient mortality (OR 1.02 [95% CI 0.29–3.57], p = 0.97), and 1-year mortality (OR 0.94 [95% CI 0.41–2.69], p = 0.88) were similar in both groups. The overall survival, plotted using the Cox proportional hazard regression, did not show a significant difference between the ICA and MCA groups (HR 0.581). CONCLUSIONS Unlike previous smaller studies, this study found that patients with malignant ICA infarction had a functional outcome and survival that was similar to those with MCA infarction after DC. Therefore, DC can be offered for malignant ICA infarction for life-saving purposes with limited functional recovery.

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