Abstract
Contrast media enhances the visualization of the anatomic structures in radiological studies, allowing internal tissues such as blood vessels, kidney, ureters, adrenals and other organs to be identified. The evolution of contrast media highlights the efforts to develop less toxic chemical agents that possess low viscosity and osmolality. However, adverse effects such as idiosyncratic reactions, and organ specific damage are well characterized. Neurotoxicity, an important and dose related effect, appears to be due to disruption of the blood-brain-barrier by the high osmolarity of the contrast agent. From devastating cortical blindness to paralysis and seizures, an array of neurological manifestations has been described. In this systematic review, we describe the contrast-induced neurologic injury following coronary angiography and discuss the proposed mechanisms of injury leading to neurotoxicity.
Highlights
Iodinated contrast media were deemed safe to use in humans in the 1920s and its first application was for a carotid angiogram performed in 1927
Case reports and case series describing adverse central nervous system (CNS) effects associated with contrast administration during coronary angiography were identified and appraised
The existing literature only describes contrast induced CNS injury associated with cerebral arteriography and arch aortography
Summary
Iodinated contrast media were deemed safe to use in humans in the 1920s and its first application was for a carotid angiogram performed in 1927. The chemical composition of contrast agents has been refined to be less toxic with the development of low-osmolality and low viscosity non-ionic alternatives. Contrast agents have revolutionized radiographic diagnostic testing, their associated adverse effects can hinder their utility [1]. Common adverse effects of intravenous contrast administration include idiosyncratic reactions such as anaphylaxis, generalized weakness, nausea and hypotension. There are dose-related effects on specific organ-systems of which contrastinduced nephropathy is the most well-known. Reactions involving the nervous system occur more frequently, exceeded only by the incidence of those involving the cardiovascular system [1,2,3,4]
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