Published online Nov 16, 2015. doi: 10.12998/wjcc.v3.i11.942
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
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.
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.