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Irreversible fatal contrast-induced encephalopathy: a case report
Wei Zhao1, Jinping Zhang1, Yun Song1
1Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, 250014, China.
BMC Neurology
|March 30, 2019
Summary
Contrast-induced encephalopathy (CIE) can be fatal, even with non-ionic low-osmolar agents like iopamidol. This case highlights the risk of irreversible brain swelling and death following diagnostic angiography, underscoring the need for vigilance.
Area of Science:
- Neurology
- Radiology
- Toxicology
Background:
- Contrast-induced encephalopathy (CIE) is a known complication of iodinated contrast agents.
- Most CIE cases are transient and reversible, with fatal outcomes rarely reported.
- Previously, fatal CIE was associated only with ionic, high-osmolar contrast agents.
Observation:
- A 71-year-old woman developed severe symptoms including headache, dizziness, nausea, and vomiting during a digital subtraction angiography (DSA).
- The DSA procedure utilized 110 ml of iopamidol, a non-ionic, low-osmolar contrast agent.
- Despite medical intervention, the patient's condition rapidly deteriorated, leading to deep coma and irreversible cerebral edema.
Findings:
- This case presents a rare instance of fatal CIE following DSA with iopamidol.
- The patient died 56 days after the procedure due to irreversible cerebral edema.
- This suggests that non-ionic, low-osmolar contrast agents can also lead to fatal outcomes.
Implications:
- Iopamidol-induced encephalopathy can have a fatal outcome, contrary to previous assumptions.
- This case expands the understanding of risks associated with non-ionic low-osmolar contrast agents.
- Clinicians should be aware of the potential for severe, irreversible CIE even with modern contrast agents.
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