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 swelling and increased density of the cerebrospinal fluid (CSF) [
1‐
3]. The incidence of CIE ranges between 0.3% and 2%, depending on the patient characteristics and type of procedure [
4‐
6]. The type of contrast agent is also of influence, as an incidence up to 4% has been reported in hyperosmolar, ionic contrast agents, which are nowadays infrequently used [
2]. CIE has also been reported in non-ionic, iso-osmolar agents, which are less neurotoxic and have a lower incidence of CIE [
1]. It is however expected that the incidence of CIE is currently increasing, because cerebrovascular diseases are more frequently treated with endovascular procedures, e.g., intra-arterial mechanical thrombectomy in acute ischemic stroke, or endovascular treatment of cerebral aneurysms, but also due to an overall increase in diagnostic imaging with contrast administration. Recently, an incidence of 1.7% has been reported in patients with acute ischemic stroke undergoing endovascular treatment [
5], although this could still be an underestimation as CIE is not always recognized. The clinical course of CIE is usually favorable with full recovery in most patients within 48–72 h [
1‐
3], but comorbidity is of relevance and contributes to the clinical outcome as illustrated by two case descriptions below.