Contrast Medium-Induced Encephalopathy After Coronary Angiography- Case Report.

Sebastian Andone,Adina Stoian,Anca Motataianu,Laura Barcutean,Rodica Balasa,Smaranda Maier,Zoltan Bajko,Valentin Ion

doi:10.2478/jccm-2021-0010

Sebastian Andone, Adina Stoian + Show 6 more

Open Access

https://doi.org/10.2478/jccm-2021-0010

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Abstract

IntroductionContrast-induced encephalopathy represents a rare, reversible complication that appears after intravenous or intra-arterial exposure to contrast agents. There is no consensus in the literature regarding the mechanism of action. However, the theoretical mechanism is set around the disruption of the blood-brain barrier and the contrast agents’ chemical properties.Case reportThe case of a 70-year-old patient, known to have hypertension and type 2 diabetes mellitus is reported. The patient had undergone a diagnostic coronary angiography during which he received 100ml of Ioversol (Optiray 350™). Soon after the procedure, the patient began experiencing a throbbing headache, followed by intense behavioural changes and aggressive tendencies. He was transferred to the Neurology Clinic. The neurological examination was without focal neurological signs; however, the patient was very aggressive and uncooperative. The CT scan revealed a mild hyper-density in the frontal lobes. MRI scan revealed no pathological changes. Conservative treatment with diuretics and hydration was administered, and the patient experienced a complete resolution of symptoms in 72 hours.ConclusionContrast-induced encephalopathy is a possible secondary complication to contrast agents and a diagnostic challenge, and it should not be overlooked, especially following procedures that use contrast agents.

Highlights

IntroductionContrast-induced encephalopathy (CIE) represents a rare but reversible complication that appears secondary to intravenous or intra-arterial exposure to iodinated contrast media
Contrast-induced encephalopathy represents a rare, reversible complication that appears after intravenous or intra-arterial exposure to contrast agents
The proposed mechanism relies on the blood-brain barrier (BBB) disruption, subsequently permitting extravasation of the contrast agent into the central nervous system (CNS) [1]

Summary

Introduction

Contrast-induced encephalopathy (CIE) represents a rare but reversible complication that appears secondary to intravenous or intra-arterial exposure to iodinated contrast media. Ten hours after the procedure the patient presented with intense behavioural changes, aggressive tendencies and severe, pulsating headache. Following a second dose of contrast agent administration, the patient’s condition worsened, presenting with severe psychomotor and behavioural disturbance He exhibited a sudden onset of hetero-aggressive behaviour towards the medical personnel and caregivers, associated with confusion and intense delirium that rendered him unable to recognise any family members. At this point, a diagnosis of CIE was suspected given the worsening of the clinical pictures and symptoms compatible with higher function impairment following the administration of the contrast agent. He was discharged ten days after the initial onset, with no neurologic sequelae

Discussion

Conclusion