Contrast-induced encephalopathy—neuroimaging findings and clinical relevance

Frederick J A Meijer,Hieronymus D Boogaarts,Ewoud D Van Dijk,Stefan C A Steens,Anil M Tuladhar

doi:10.1007/s00234-022-02930-z

Frederick J A Meijer, Hieronymus D Boogaarts + Show 3 more

Open Access

https://doi.org/10.1007/s00234-022-02930-z

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Abstract

Contrast-induced encephalopathy (CIE) is a rare encephalopathic condition after the administration of a contrast agent. The diagnosis of CIE is challenging because of the heterogeneity and non-specificity of the clinical presentation. The clinical course is usually favorable with full recovery within 48–72 h in most patients, although comorbidity is of relevance and contributes to the clinical outcome. It is expected that the incidence of CIE is currently increasing, due to an increase in endovascular and diagnostic imaging procedures using iodinated contrast. It is important to include CIE in the differential diagnosis when patients deteriorate during, or immediately after, contrast administration, even when only a small amount of non-ionic contrast agent is used. When CIE is considered to be the most likely explanation for the clinical symptoms, it is advised to refrain from unnecessary additional contrast studies such as angiography or perfusion CT.

Highlights

Contrast-induced encephalopathy (CIE) is a rare complication following the intravenous or intra-arterial administration of an iodinated contrast agent
Brain CT showed no evidence of intracranial hemorrhage, and CT angiography demonstrated an occlusion of the right M1 branch of the middle cerebral artery (MCA)
Contrast-induced encephalopathy can occur after different types of diagnostic or therapeutic procedures, direct intra-arterial or intrathecal contrast administration, Fig. 1 Case 1

Summary

Introduction

Contrast-induced encephalopathy (CIE) is a rare complication following the intravenous or intra-arterial administration of an iodinated contrast agent. Clinical manifestations include visual disturbances (transient cortical blindness is the most common manifestation), motor or sensory deficits, aphasia, altered consciousness, and seizures [1–3]. Due to the heterogeneity of the clinical presentation and the broad differential diagnosis, neuroimaging has a crucial role in the diagnosis of CIE while excluding other more frequent causes, such as recurrent cerebral ischemia, hemorrhage, and posterior reversible encephalopathy syndrome (PRES). On brain CT, CIE is characterized by hyperdense brain

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