Contrast-induced encephalopathy mimicking stroke after a second cerebral DSA: an unusual case report

Abstract Background Contrast-induced encephalopathy (CIE) is a rare complication of the angiography process. CIE may mimic stroke symptoms clinically and subarachnoid hemorrhage radiologically. Previous CIE cases occurred after the initial digital subtraction angiography (DSA) scan. Here, we encount...

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Autores principales:	Jiaying Li, Guanshu Qi, Huani Zhang, Gang Chen, Shuting Wang, Minli Yan, Zhichao Sun
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Cerebral angiography Contrast media Encephalopathy Stroke Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/8be181a579974dc4bd7306479c1a5695
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spelling	oai:doaj.org-article:8be181a579974dc4bd7306479c1a56952021-11-07T12:23:24ZContrast-induced encephalopathy mimicking stroke after a second cerebral DSA: an unusual case report10.1186/s12883-021-02457-51471-2377https://doaj.org/article/8be181a579974dc4bd7306479c1a56952021-11-01T00:00:00Zhttps://doi.org/10.1186/s12883-021-02457-5https://doaj.org/toc/1471-2377Abstract Background Contrast-induced encephalopathy (CIE) is a rare complication of the angiography process. CIE may mimic stroke symptoms clinically and subarachnoid hemorrhage radiologically. Previous CIE cases occurred after the initial digital subtraction angiography (DSA) scan. Here, we encountered an unusual case of CIE mimicking a stroke with an internal carotid artery (ICA) aneurysm and ipsilateral ICA stenosis that occurred after a second DSA procedure. Case presentation A 77-year-old female with a history of hypertension and coronary heart disease underwent two cerebral DSA procedures over 1 week. She was given the same nonionic and iso-osmolar Visipaque agent (smaller than 200 ml) for both procedures. However, neurological complications only occurred after the second DSA procedure. On the first diagnostic cerebral DSA, she was diagnosed with an intracranial aneurysm of the left ICA with moderate stenosis (approximately 50%) in the initial part of the ipsilateral ICA. However, after the second aneurysm embolization procedure by DSA, she developed right hemiplegia, aphasia, and epilepsy, mimicking left middle cerebral artery occlusion. An emergency CT showed a diffuse hyperdensity in the left subarachnoid space, mimicking SAH. MRI demonstrated that the lesion was hyperintense on T2WI, FLAIR imaging, and DWI but was normal on ADC mapping. On postoperative Day 6, her neurologic deficits had completely resolved after initial fluid restriction, corticosteroid treatment, and rehydration. Conclusion This case indicates that clinicians should consider the occurrence of CIE following any angiography procedure, even if the initial cerebral DSA procedure is successful and without complications.Jiaying LiGuanshu QiHuani ZhangGang ChenShuting WangMinli YanZhichao SunBMCarticleCerebral angiographyContrast mediaEncephalopathyStrokeNeurology. Diseases of the nervous systemRC346-429ENBMC Neurology, Vol 21, Iss 1, Pp 1-5 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cerebral angiography Contrast media Encephalopathy Stroke Neurology. Diseases of the nervous system RC346-429
spellingShingle	Cerebral angiography Contrast media Encephalopathy Stroke Neurology. Diseases of the nervous system RC346-429 Jiaying Li Guanshu Qi Huani Zhang Gang Chen Shuting Wang Minli Yan Zhichao Sun Contrast-induced encephalopathy mimicking stroke after a second cerebral DSA: an unusual case report
description	Abstract Background Contrast-induced encephalopathy (CIE) is a rare complication of the angiography process. CIE may mimic stroke symptoms clinically and subarachnoid hemorrhage radiologically. Previous CIE cases occurred after the initial digital subtraction angiography (DSA) scan. Here, we encountered an unusual case of CIE mimicking a stroke with an internal carotid artery (ICA) aneurysm and ipsilateral ICA stenosis that occurred after a second DSA procedure. Case presentation A 77-year-old female with a history of hypertension and coronary heart disease underwent two cerebral DSA procedures over 1 week. She was given the same nonionic and iso-osmolar Visipaque agent (smaller than 200 ml) for both procedures. However, neurological complications only occurred after the second DSA procedure. On the first diagnostic cerebral DSA, she was diagnosed with an intracranial aneurysm of the left ICA with moderate stenosis (approximately 50%) in the initial part of the ipsilateral ICA. However, after the second aneurysm embolization procedure by DSA, she developed right hemiplegia, aphasia, and epilepsy, mimicking left middle cerebral artery occlusion. An emergency CT showed a diffuse hyperdensity in the left subarachnoid space, mimicking SAH. MRI demonstrated that the lesion was hyperintense on T2WI, FLAIR imaging, and DWI but was normal on ADC mapping. On postoperative Day 6, her neurologic deficits had completely resolved after initial fluid restriction, corticosteroid treatment, and rehydration. Conclusion This case indicates that clinicians should consider the occurrence of CIE following any angiography procedure, even if the initial cerebral DSA procedure is successful and without complications.
format	article
author	Jiaying Li Guanshu Qi Huani Zhang Gang Chen Shuting Wang Minli Yan Zhichao Sun
author_facet	Jiaying Li Guanshu Qi Huani Zhang Gang Chen Shuting Wang Minli Yan Zhichao Sun
author_sort	Jiaying Li
title	Contrast-induced encephalopathy mimicking stroke after a second cerebral DSA: an unusual case report
title_short	Contrast-induced encephalopathy mimicking stroke after a second cerebral DSA: an unusual case report
title_full	Contrast-induced encephalopathy mimicking stroke after a second cerebral DSA: an unusual case report
title_fullStr	Contrast-induced encephalopathy mimicking stroke after a second cerebral DSA: an unusual case report
title_full_unstemmed	Contrast-induced encephalopathy mimicking stroke after a second cerebral DSA: an unusual case report
title_sort	contrast-induced encephalopathy mimicking stroke after a second cerebral dsa: an unusual case report
publisher	BMC
publishDate	2021
url	https://doaj.org/article/8be181a579974dc4bd7306479c1a5695
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Contrast-induced encephalopathy mimicking stroke after a second cerebral DSA: an unusual case report

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