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Case Reports
. 2021 Jun 14:12:273.
doi: 10.25259/SNI_44_2021. eCollection 2021.

Contrast-induced encephalopathy and permanent neurological deficit: A case report and literature review

Paola Maria Francesca Cristaldi #  1   2 , Alessandra Polistena #  1   3 , Mirko Patassini  3 , Camilla de Laurentis  1   2 , Carlo Giussani  1   2 , Paolo Remida  3
Affiliations
Case Reports

Contrast-induced encephalopathy and permanent neurological deficit: A case report and literature review

Paola Maria Francesca Cristaldi et al. Surg Neurol Int. .

Abstract

Background: Contrast-induced encephalopathy (CIE) is a rare condition that occurs after intravenous or intra-arterial contrast agent administration. Patients generally show different ranges of neurological deficits, which generally resolve themselves spontaneously within 24-48 h or in rare cases within 2 weeks.

Case description: We report a case of CIE in a 54-year-old woman during retreatment for recanalization of communicating anterior artery aneurysm and with no history of allergic reaction to contrast agent. After the procedure, the patient developed right hemiplegia and complete aphasia; an MRI performed at 6 days excluded any signs of new ischemia and revealed a hyperintense signal on FLAIR sequences in the left cortical precentral gyrus corresponding to a hyperintense signal on DWI, suggesting a vasogenic edema. After 6 months, she clinically improved even if her previous neurological status was never restored while radiological findings did not change.

Conclusion: According to the literature, many risk factors may play a role in the pathogenesis of CIE: we hypothesized that, among all of them, chronic hypertension and previous cerebral ischemic lesions were the most important in our case. Further studies are necessary to find the correlation between possible risk factors and neurotoxicity.

Keywords: Brain aneurysm; Cerebral angiography; Contrast agent; Encephalopathy; Neurological deficit.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
(a and b): a postoperative CT scan shows an abnormal subarachnoid contrast enhancement zone and a focal left parasagittal frontal hyperdense area. (c) A CT scan performed at 20 h shows a resorption of the subarachnoid hyperdensity and a new left parasagittal frontal hypodense area. (d) An MRI performed at 6 days reveals a hyperintense signal on FLAIR sequences in the left cortical precentral gyrus (as in case of vasogenic edema), excluding any signs of new ischemia.
Figure 2:
Figure 2:
An MRI performed at 6 months shows the same hyperintense signal on FLAIR.
See this image and copyright information in PMC

References

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