Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2015; 3(11): 942-945
Published online Nov 16, 2015. doi: 10.12998/wjcc.v3.i11.942
Contrast induced neurotoxicity following coronary angiogram with Iohexol in an end stage renal disease patient
Narasimha Swamy Gollol Raju, Deepak Joshi, Ramesh Daggubati, Assad Movahed
Narasimha Swamy Gollol Raju, Department of Internal Medicine, East Carolina University-Brody School of Medicine, Greenville, NC 27834, United States
Deepak Joshi, Ramesh Daggubati, Assad Movahed, Department of Cardiovascular Sciences, East Carolina University-Brody School of Medicine, Greenville, NC 27834, United States
Author contributions: All authors contributed to the acquisition of information, writing and revision of this case report.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at East Carolina University.
Informed consent statement: The patient involved in this study gave informed consent authorizing use and disclosure of protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Assad Movahed, MD, FACC, FACP, Department of Cardiovascular Sciences, East Carolina University-Brody School of Medicine, 115 Heart Drive, Greenville, NC 27834, United States. movaheda@ecu.edu
Telephone: +1-252-7444400 Fax: +1-252-7447725
Received: May 6, 2015
Peer-review started: May 8, 2015
First decision: July 10, 2015
Revised: July 23, 2015
Accepted: September 7, 2015
Article in press: September 8, 2015
Published online: November 16, 2015
Processing time: 188 Days and 17.1 Hours
Abstract

Neurotoxicity is an infrequent adverse reaction to iodinated contrast agents. Contrast induced neurotoxicity following coronary angiogram is very rare. Renal disease is a risk factor for contrast induced neurotoxicity. We report a case of contrast induced neurotoxicity following coronary angiogram and intervention using Iohexol (Omnipaque 350) in an end stage renal disease patient on peritoneal dialysis who had prior exposure to iodinated contrast without any adverse reaction. Hemodialysis had to be initiated for rapid removal of the contrast agent with subsequent complete resolution of neurological deficits. This case highlights the need for interventionalists to be aware of an important adverse reaction to iodinated contrast agents, especially in individuals with renal dysfunction, and that neurotoxicity is a possibility even with prior uneventful exposures. The role and timing of hemodialysis in contrast induced neurotoxicity in patients with chronic kidney disease and in those without chronic kidney disease needs further deliberation.

Keywords: Coronary angiogram; End stage renal disease; Hemodialysis; Iodinated contrast agent; Neurotoxicity

Core tip: Contrast induced neurotoxicity following coronary angiogram is very rare. Interventionalists should be aware of this rare complication especially in patients with end stage renal disease (ESRD). Iodinated contrast media can be effectively removed from the blood by dialysis. Hemodialysis is a better modality for rapid removal of contrast agent compared to peritoneal dialysis. Hemodialysis should be considered in life-threatening adverse reactions when supportive care alone is not sufficient. More studies are needed to further delineate the role and timing of hemodialysis following coronary angiogram and the optimal dosage of contrast media in ESRD patients to prevent this infrequent but potentially life threatening adverse reaction.