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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

Kazutaka Nakao
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi
,
Girish Joshi
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi
2   Department of Neurosurgery, Apollo Speciality Hospital, Bengaluru, Karnataka, India
,
Yuichi Hirose
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi
3   Department of Neurosurgery, Fujita Health University, Nagoya, Aichi
,
Riki Tanaka
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi
,
Yasuhiro Yamada
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi
,
Kyosuke Miyatini
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi
,
Binoy Thavara
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi
4   Department of Neurosurgery, Government Medical College, Thrissur, Kerala, India
,
Tsukasa Kawase
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi
,
Yoko Kato
1   Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi
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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

Financial support and sponsorship

Nil.




Publication History

Received: 26 February 2020

Accepted: 29 April 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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