CASE REPORT   Open access

Italian Journal of Emergency Medicine 2022 August;11(2):126-8

DOI: 10.23736/S2532-1285.22.00140-9

Copyright © 2022 THE AUTHORS

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language: English

Contrast-induced encephalopathy with persistent neurological deficit

Maria G. MOSCONI ¹, Giorgio MARAZITI ¹ ✉, Pasquale CIANCI ², Andrea ALBERTI ¹, Maurizio PACIARONI ¹

¹ Stroke Unit, Department of Internal, Vascular and Emergency Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy; ² Emergency Department, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy

Contrast-induced encephalopathy (CIE) or neurotoxicity (CIN) is a rare central-nervous system (CNS) complication following the administration of endovascular contrast media used in several radiologic exams. Because of its low incidence, it is a challenging diagnosis, going in differential diagnosis with other acute CNS diseases such as ischemic and hemorrhagic stroke, subarachnoid hemorrhage, epilepsy, toxic/metabolic encephalopathy, posterior reversible encephalopathy syndrome (PRES). The most common clinical features are cortical blindness, focal neurological deficits, cortical signs, altered mental status, headache, and seizures. Prognosis is generally favorable with complete recovery within days, but even rarer cases of persistent neurological deficits have been described. We present a case of persistent CIE after contrast administration to perform a coronary angiography. Following the procedure, the patient experienced left hemiplegia, complete visual deficit, left hemineglect and psychomotor agitation. An emergency angio-computed tomography brain scan showed no occlusion of large vessels or intracranial bleeding. A following brain magnetic resonance imaging (MRI) showed small diffusion-restricted areas in the right peritrigonal region and the right cortico-subcortical posterior frontal and parietal region. At the discharge, alertness was recovered but there was a persistent left upper limb paresis. At the 6^th months follow-up, the patient was functionally autonomous without focal deficits. A control brain MRI showed only the persistence of an isolated parietal lesion.

KEY WORDS: Contrast media; Stroke; Coronary angiography; Toxicity