Rare cases of contrast-induced encephalopathies

Kazutaka Nakao; Girish Joshi; Yuichi Hirose; Riki Tanaka; Yasuhiro Yamada; Kyosuke Miyatini; Binoy Damodar Thavara; Tsukasa Kawase; Yoko Kato

doi:10.4103/ajns.AJNS_68_20

An Official publication of The Asian Congress of Neurological Surgeons (AsianCNS)

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CASE REPORT

Year : 2020 | Volume : 15 | Issue : 3 | Page : 786-793

Rare cases of contrast-induced encephalopathies

Kazutaka Nakao¹, Girish Joshi², Yuichi Hirose³, Riki Tanaka¹, Yasuhiro Yamada¹, Kyosuke Miyatini¹, Binoy Damodar Thavara⁴, Tsukasa Kawase¹, Yoko Kato¹
¹ Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan
² Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan; Department of Neurosurgery, Apollo Speciality Hospital, Bengaluru, Karnataka, India
³ Department of Neurosurgery, Fujita Health University Bantane Hospital; Department of Neurosurgery, Fujita Health University, Nagoya, Aichi, Japan
⁴ Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi, Japan; Department of Neurosurgery, Government Medical College, Thrissur, Kerala, India

Correspondence Address:
Dr. Kazutaka Nakao
Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Aichi
Japan

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ajns.AJNS_68_20

Cortical blindness (CB) due to contrast-induced encephalopathy is a rare complication in endovascular procedure. Although exact mechanism is not known, disruption of blood–brain barrier (BBB) by contrast agent is supposed to be caused. We report two cases of contrast-induced encephalopathies after coil embolization of unruptured aneurysm. A 68-year-old woman with unruptured basilar artery aneurysm was treated with endovascular stent-assisted coil embolization. The procedure was successfully accomplished within 172 min using about 160 ml of contrast medium (iopamidol). However, she manifested with CB 3 h after the procedure and seizure on the next day. Immediate computed tomography revealed the cortical enhancement in both occipital lobes. Diffusion-weighted imaging–magnetic resonance imaging and fluid-attenuated inversion recovery sequence 1 day after the procedure revealed edema in both occipital lobes with no findings of ischemia or hyperperfusion. Electroencephalography showed sharp and slow waves in both occipital lobes. She required endotracheal intubation on day 2 to maintain airways and breathing. Her sensorium improved 4 days after the procedure with administration of steroid and anticonvulsant. She was extubated on day 4 after the procedure. She was discharged with persisting CB as a sequel.

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