Neurointervention.  2023 Mar;18(1):58-62. 10.5469/neuroint.2022.00353.

Fully Reversible Contrast-Induced Encephalopathy Mimicking Stroke after Flow Diverter Treatment of Carotid Cave Aneurysm

• Diamandis E
• Swiatek VM
• Behme D

• KMID: 2539947
• DOI: http://doi.org/10.5469/neuroint.2022.00353

Abstract

Contrast-induced encephalopathy (CIE) is a rare complication of coronary and neurointerventional procedures. The condition is believed to arise from endothelial damage secondary to exposure to iodinated contrast media. A wide spectrum of clinical manifestations has been reported including seizures, cortical blindness, and focal neurological deficits. This report details the case of fully reversible CIE mimicking severe anterior circulation stroke in a 55-year-old female following elective endovascular treatment with a flow diverter of a carotid cave aneurysm. The patient was managed conservatively with intravenous hydration and steroids and showed an excellent prognosis with supportive management.

Keyword

Contrast-induced encephalopathy; Contrast media; Contrast-induced neurotoxicity; Ischemic attack, transient; Cerebral angiography; Stroke mimics

Figure

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  Fig. 1. (A) Anteroposterior angiographic run showing carotid cave aneurysm of left internal carotid artery (ICA). (B) 3D rotational angiogram of the same aneurysm. (C) Unsubstracted image after flow diverter implantation showing intraaneurysmal contrast stagnation and also showing the superimposed flow diverter of the right ICA implanted 6 weeks earlier. (D) Post-procedural computed tomography (CT) showing sulcal hyperdensities mimicking subarachnoid hemorrhage. (E, F) Repeat non-contrast CT at 4 hours and 30 hours, respectively, showing gradual regression of previous findings and ruling out ischemic changes. (G) Magnetic resonance imaging on postprocedural day 5 showing a few punctate diffusion-weighted imaging hits.

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