Persistent neurological deficit from iodinated contrast encephalopathy following intracranial aneurysm coiling. A case report and review of the literature

Abstract

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.

Figure 1

A) Non contrast CT brain immediately following coiling shows abnormal cortical contrast enhancement and edema in the left hemisphere and subarachnoid contrast enhancement. B) Axial FLAIR image on day 11 post coiling shows residual signal change particularly in the precentral and postcentral gyri. C) Contrast T1-weighted image on day 11 shows enhancement in the precentral gyrus, indicating persistent breakdown in the blood-brain barrier. D) Axial FLAIR image three months post coiling shows persistent signal change in the precentral gyrus, consistent with gliosis (arrow).