Rare cases of contrast-induced encephalopathies

Kazutaka Nakao; Girish Joshi; Yuichi Hirose; Riki Tanaka; Yasuhiro Yamada; Kyosuke Miyatini; Binoy Thavara; Tsukasa Kawase; Yoko Kato

doi:10.4103/ajns.AJNS_68_20

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(03): 786-793
DOI: 10.4103/ajns.AJNS_68_20

Case Report

Rare cases of contrast-induced encephalopathies

Authors

Kazutaka Nakao

¹Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi
Girish Joshi

¹Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi

²Department of Neurosurgery, Apollo Speciality Hospital, Bengaluru, Karnataka, India
Yuichi Hirose

¹Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi

³Department of Neurosurgery, Fujita Health University, Nagoya, Aichi
Riki Tanaka

¹Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi
Yasuhiro Yamada

¹Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi
Kyosuke Miyatini

¹Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi
Binoy Thavara

¹Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi

⁴Department of Neurosurgery, Government Medical College, Thrissur, Kerala, India
Tsukasa Kawase

¹Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi
Yoko Kato

¹Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi

Abstract

Cortical blindness (CB) due to contrast-induced encephalopathy is a rare complication in endovascular procedure. Although exact mechanism is not known, disruption of blood–brain barrier (BBB) by contrast agent is supposed to be caused. We report two cases of contrast-induced encephalopathies after coil embolization of unruptured aneurysm. A 68-year-old woman with unruptured basilar artery aneurysm was treated with endovascular stent-assisted coil embolization. The procedure was successfully accomplished within 172 min using about 160 ml of contrast medium (iopamidol). However, she manifested with CB 3 h after the procedure and seizure on the next day. Immediate computed tomography revealed the cortical enhancement in both occipital lobes. Diffusion-weighted imaging–magnetic resonance imaging and fluid-attenuated inversion recovery sequence 1 day after the procedure revealed edema in both occipital lobes with no findings of ischemia or hyperperfusion. Electroencephalography showed sharp and slow waves in both occipital lobes. She required endotracheal intubation on day 2 to maintain airways and breathing. Her sensorium improved 4 days after the procedure with administration of steroid and anticonvulsant. She was extubated on day 4 after the procedure. She was discharged with persisting CB as a sequel.

Key-words:

Cerebral angiogram - computed tomography angiogram - contrast-induced encephalopathy - cortical blindness

Full Text

References

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