Posterior reversible encephalopathy syndrome overlapping contrast-induced encephalopathy after coronary angiography

Excerpt

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological disorder characterised by acute-onset neurological symptoms (typically seizures, encephalopathy, headache and visual disturbances) and reversible subcortical vasogenic brain oedema related to heterogeneous aetiologies. Brain imaging usually reveals vasogenic oedema predominantly involving the parieto-occipital regions. PRES is generally reversible, both radiologically and clinically [1]. On the other hand, contrast-induced encephalopathy (CE) has been described as a rare complication of angiography. It was first reported in 1970 as a transient cortical blindness and focal neurological deficits after coronary angiography (CAG) [2]. Clinical effects of neurotoxicity from iodinated contrast agents include visual fields defects, encephalopathy, seizures and focal neurological deficits. Also, CE is extensively reported to have a benign clinical course [2]. The reported incidence is 0.06% of patients undergoing CAG, 0.3–1% of patients undergoing vertebral angioplasty and 2.9% with endovascular coil treatment of posterior circulation aneurysm [2]. As already supposed, there is a clinical and neuroradiological overlap between the two syndromes [3]. Here, we report a case of typical PRES following CAG, and we discuss the pathophysiological overlap with CE. …