Contrast agent neurotoxicity presenting as subarachnoid hemorrhage

Area of Science:

• Neurology
• Radiology
• Cardiology

Background:

• Coronary angiography and stent placement are common procedures.
• Heparin is frequently used as an anticoagulant during these interventions.
• Intravascular contrast agents are essential for visualizing coronary arteries.

Observation:

• A patient presented with clinical and radiological signs suggestive of acute subarachnoid hemorrhage.
• These findings emerged shortly after receiving a high dose of heparin and contrast medium during coronary angiography.
• Initial assessment indicated potential bleeding in the subarachnoid space.

Findings:

• Computed tomography (CT) revealed subarachnoid enhancement consistent with contrast material.
• The enhancement was attributed to the intravascular contrast agent, not subarachnoid hemorrhage.
• This represents an unusual case of contrast-induced neurotoxicity.

Implications:

• Contrast neurotoxicity can mimic serious neurological conditions like subarachnoid hemorrhage.
• Radiologists and clinicians should consider contrast agent side effects in differential diagnoses.
• This case underscores the importance of recognizing rare adverse reactions to common medical procedures and agents.