Contrast-induced encephalopathy after cerebral DSA using iodixanol: a case report and literature review

Abstract

Abstract Contrast-induced encephalopathy (CIE) is an uncommon and self-limited complication which has been mostly reported to be associated with coronary angiography, but the recent literature shows its association with cerebral endovascular therapy as well. It can mimic seizure, confusion, focal motor and sensory deficits, mental aberrations, cortical blindness and ophthalmoplegia. Here, we present a CIE after digital subtraction angiography (DSA) using iodixanol (non-ionic, low-osmolar). A 74-year-old man presents with slurred speech, facial weakness, right limb numbness and weakness is admitted. Brain MRI detects a subacute infarction of posterior limb of left internal capsule. Given a history of asymptomatic stenosis of vertebral artery bilaterally, he is conducted DSA for further diagnosis. A total of 100 ml of iodixanol is used during DSA. The patient experiences restlessness, confused, and hematemesis after the procedure, followed by generalized tonic-clonic seizure, right eye gaze, and coma. The radiological signs and clinical status are gradually recovery after symptomatic treatment. This case indicates the potential for contrast to induce encephalopathy.