Contrast-induced encephalopathy after percutaneous peripheral intervention.

Area of Science:

• Neurology
• Radiology
• Cardiovascular Medicine

Background:

• Contrast-induced encephalopathy (CIE) is a rare but serious complication associated with radiographic contrast agents.
• Peripheral arterial disease necessitates interventions like angioplasty, which involve the use of contrast media.
• Non-ionic contrast agents, such as iohexol, are generally considered safer but can still precipitate adverse neurological events.

Observation:

• A 66-year-old male with peripheral arterial disease underwent lower extremity angiography and angioplasty with stent placement.
• Following the procedure, the patient developed acute neurological symptoms including confusion, cortical blindness, and a seizure.
• Cerebral imaging ruled out hemorrhage, and symptoms resolved within 24 hours with hydration and sedation.

Findings:

• The clinical presentation and imaging findings were consistent with a diagnosis of contrast-induced encephalopathy (CIE).
• The non-ionic contrast agent, iohexol, was implicated as the causative agent in this case of CIE.
• The rapid resolution of neurological deficits highlights the often-transient nature of CIE.

Implications:

• This case underscores the importance of recognizing CIE as a potential complication, even with non-ionic contrast agents.
• Prompt diagnosis and supportive management, including hydration and sedation, are crucial for favorable outcomes in CIE.
• Further research into the mechanisms and risk factors for CIE may help in its prevention and management.