Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2023; 11(10): 2260-2266
Published online Apr 6, 2023. doi: 10.12998/wjcc.v11.i10.2260
Unilateral contrast-induced encephalopathy with contrast medium exudation: A case report
Zhi-Yuan Zhang, Hang Lv, Pei-Jian Wang, Dan-Yang Zhao, Li-Yong Zhang, Ji-Yue Wang, Ji-Heng Hao
Zhi-Yuan Zhang, Pei-Jian Wang, Li-Yong Zhang, Ji-Yue Wang, Ji-Heng Hao, Department of Neurosurgery, Liaocheng People’s Hospital, Liaocheng 252001, Shandong Province, China
Hang Lv, School of Clinical Medicine, Weifang Medical University, Weifang 261053, Shandong Province, China
Dan-Yang Zhao, Department of Neurology, Shenyang First People’s Hospital, Shenyang 110041, Liaoning Province, China
Author contributions: Zhang ZY contributed to conception and design of experiments, implementation of research, collection of data, analysis/interpretation of data, and drafting articles; Lv H contributed to conduct research, analyze/interpret data, and draft articles; Wang PJ contributed to collect data and draft articles; Zhao DY contributed to analyze/interpret data, draft articles, and critical review of the intellectual content of articles; Zhang LY contributed to work support, access to research funding, guidance, and supportive contributions; Wang JY contributed to work support, access to research funding , guidance, and supportive contributions; Hao JH contributed to conception and design of experiments, guidance, and supportive contributions.
Informed consent statement: Informed written consent was obtained from the patients for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ji-Heng Hao, Doctor, Professor, Department of Neurosurgery, Liaocheng People’s Hospital, No. 45 Huashan Road, Economic Development Zone, Dongchangfu District, Liaocheng 252001, Shandong Province, China. haojiheng@163.com
Received: November 3, 2022
Peer-review started: November 3, 2022
First decision: December 26, 2022
Revised: February 8, 2023
Accepted: March 3, 2023
Article in press: March 3, 2023
Published online: April 6, 2023
Processing time: 146 Days and 23.3 Hours
Abstract
BACKGROUND

Contrast-induced encephalopathy (CIE) is a rare transient, reversible abnormality in the structure or function of the nervous system caused by the intravascular use of contrast agents. CIE can present with a range of neurological manifestations, including focal neurological deficits (hemiplegia, hemianopia, cortical blindness, aphasia, and parkinsonism) and systemic symptoms (confusion, seizures, and coma). However, if not accurately diagnosed and treated in a timely manner, CIE can cause irreversible damage to patients, especially critically ill patients.

CASE SUMMARY

A male in his 50 s, 2 h after digital subtraction angiography, had a progressive disorder of consciousness, mixed aphasia, bilateral pupillary sluggish light reflex, and right limb weakness. Seven hours after the procedure, he developed unconsciousness, high fever (39.5 °C), seizures, hemiplegia, neck stiffness (+), and right Babinski signs (+). computed tomography (CT) findings 2 h postprocedure were very confusing and led us to misdiagnose the patient with subarachnoid hemorrhage. Brain CT was performed again 7 h after the procedure. Compared with the CT 2 h after the procedure, the CT 7 h after the procedure showed that the manifestations of subarachnoid hemorrhage in the left cerebral hemisphere had disappeared and were replaced by brain tissue swelling, and the cerebral sulci had disappeared. Combined with the clinical manifestations of the patient and after the exclusion of subarachnoid hemorrhage and cerebrovascular embolism, we diagnosed the patient with CIE, and intravenous fluids were given for adequate hydration, as well as mannitol, albumin dehydration, furosemide and the glucocorticoid methylprednisolone. After 17 d of active treatment, the patient was discharged with no sequelae.

CONCLUSION

CIE should be taken seriously, but it is easily misdiagnosed, and once CIE is diagnosed, rapid, accurate diagnosis and treatment are critical steps. Whether a follow-up examination using a contrast agent can be performed should be closely evaluated, and the patient should be fully informed of the associated risks.

Keywords: Contrast agents; Diagnosis; Encephalopathy; Mechanisms; Treatment

Core Tip: Contrast-induced encephalopathy (CIE) is a rare disease induced by the injection of contrast agents. In this case, unilateral CIE was caused by a long time of internal carotid arteriogram on left side and a large amount of contrast agent. The onset was misdiagnosed as subarachnoid hemorrhage at an early stage, and he was discharged without sequelae after 18 d of diagnosis and treatment of CIE. The main treatment measures are corticosteroids, dehydration and diuresis, and adequate hydration. Rapid, accurate diagnosis and treatment are critical steps. Whether the follow-up examination using contrast agent can be done should be closely evaluated and fully informed.