Published online Apr 6, 2023. doi: 10.12998/wjcc.v11.i10.2260
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
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.
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.
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.
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.