Contrast Induced Encephalopathy: a rare complication in a patient on Peritoneal Dialysis with several risk factors

Abstract

Major adverse renal and cardiovascular events (MARCE) are reported for high-risk patients undergoing intra-arterial procedures, even if performed with iso-osmolar contrast media (CM). We report a case of Contrast Induced Encephalopathy (CIE) in a Peritoneal Dialysis (PD)-patient, affected by diabetes, hypertension and chronic heart failure. A 78-year-old PD-patient (diuresis 1000 ml) underwent a Percutaneous Angioplasty (PTA) of carotid. Immediately after the exam he developed mental confusion and aphasia. Encephalic CT scan and MRI excluded ischemia or haemorrhage, but both showed cerebral oedema; EEG showed right hemisphere abnormalities, sequelae of recent ischemia. Mannitol and steroids were administered to reduce oedema and additional PD exchange was performed with depurative aim. Within 2 days the patient completely recovered. CIE mimics severe neurological diseases, and it should be considered as differential diagnosis if symptoms come out soon after intra-arterial administration of CM, especially in high-risk patients. Our patient suffered from diabetes, CKD, hypertension, chronic heart failure, possible contributing factors to the development of CIE. Moreover, this clinical scenario is noteworthy because the development in a patient who underwent PD had never been described before.