Learning objectives
To provide a pictorial review of typical imaging findings in iodinated contrast-induced encephalopathy after neurovascular interventional procedures, with special focus on the role of CT and MR. To evaluate its recurrence and clinical manifestations, and discuss the appropriate differential diagnosis with other neurovascular complications after cerebral angiography, in order to speculate an effective diagnostic approach.
Background
Cerebrovascular complications related to neuroendovascular treatments occur in approximately 2% to 5% of cases. They are mostly related to catheterization and include vasospasm, arterial dissection, pseudoaneurysm and embolism.
Conversely, contrast-induced encephalopathy (CIE) is a rare and less known complication. It is an acute and reversible neurological condition associated with intra-arterial administration of iodinated contrast medium during neurovascular interventional procedures.
This induced encephalopathy, mostly described as a temporary and unpredictable event, seems to be related to the capacity of contrast medium to penetrate the blood-brain barrier...
Findings and procedure details
Imaging findings may be subtle.
A non-contrast brain CT is usually performed at the time of symptoms onset, in order to rule out other main causes of an acute neurologic deficit (especially more urgent and frequent events, such as embolism). The typical pattern consist of variable cortical and subarachnoid hyperdensity, associated with mass effect due to oedema. This pattern of “gyriform” hyperdensity is thought to be caused by contrast leakage, related to focal blood–brain barrier disruption.
After CIE diagnosis, the patient is generally transferred to...
Conclusion
Typical CT findings in CIE consist of variable cortical and subarachnoid hyperdensity, associated with mass effect due to oedema. MR pattern includes T2-w/FLAIR cortical/subcortical hyperintensity in the affected region, sulcal effacement, and a corresponding slight DWI hyperintensity without any change on the apparent diffusion coefficient (ADC) maps.
Correct interpretation of imaging findings is crucial in this condition, in fact the right diagnosis of CIE permits to avoid the risks associated with erroneous treatment, such as administration of thrombolytic agents or additional contrast agent use.
Some...
Personal information and conflict of interest
A. Bartolo; Rome/IT - nothing to disclose A. Pedicelli; ROMA (RM)/IT - nothing to disclose A. Alexandre; Rome/IT - nothing to disclose F. Giubbolini; Sienna/IT - nothing to disclose I. Valente; Rome/IT - nothing to disclose E. Lozupone; Rome/IT - nothing to disclose F. D'argento; Taviano (LE)/IT - nothing to disclose C. Colosimo; Rome/IT - nothing to disclose
References
Transient Encephalopathy from Angiographic Contrast: A Rare Complication in Neurointerventional Procedures. Leopoldo Guimaraens, Elio Vivas, Andre ́s Fonnegra, Teresa Sola, Lluis Soler, Ernest Balaguer, Jaime Medrano, Carlo Gandolfo, Alfredo Casasco (2010).
Persistent neurological deficit from Iodinated Contrast Encephalopathy Following Intracranial Aneurysm Coiling A Case Report and Review of the literature S. Leong, N.F. Fanning (2012)
Transient contrast encephalopathy after carotid artery stenting mimicking diffuse subarachnoid hemorrhage: a case report. Fang HY, Kuo YL, Wu CJ(2009)
An atypical case of contrast-induced encephalopathy after carotid artery stenting....