Nerve.  2021 Apr;7(1):7-10. 10.21129/nerve.2021.7.1.7.

Contrast-Induced Encephalopathy after Coil Embolization: A Case Report and Review of Literature

• Chung Y
• Ryu J
• Kim EJ

• KMID: 2543203
• DOI: http://doi.org/10.21129/nerve.2021.7.1.7

Abstract

Contrast-induced encephalopathy (CIE) is a rare and unexpected complication after coil embolization to treat cerebral aneurysm. A 66-year-old woman underwent secondary coil embolization with iodixanol for recanalization of the left middle cerebral artery aneurysm. Preoperative computed tomography revealed encephalomalacia in the left frontal and temporal lobe caused by previous aneurysmal rupture. Two hr after the procedure, the patient showed status epilepticus and right hemiplegia. Fluid-attenuated inversion recovery imaging revealed extensive involvement of CIE in the left hemisphere. CIE-related symptoms gradually resolved with conservative treatment including antiepileptic drugs, mannitol, and methylprednisolone. Two-month follow-up magnetic resonance imaging revealed that the edema markedly improved in the parietal area but remained in the frontal area, and the patient completely recovered without any sequelae. Even iodixanol, an iso-osmolar contrast medium, could lead to CIE manifesting as a serious condition such as status epilepticus. Endovascular neurosurgeons should always be aware of CIE, especially when encephalomalacia is present.

Keyword

Brain diseases; Contrast media; Encephalomalacia; Status epilepticus