Transient contrast induced neurotoxicity after coronary angiography: A contrast re-challenge case

Area of Science:

• Neurology
• Cardiology
• Radiology

Background:

• Contrast induced neurotoxicity (CIN) is an infrequent complication following cardiac catheterization procedures.
• Re-exposure to iodinated contrast media poses a risk for recurrent CIN, necessitating careful patient management.

Observation:

• A 60-year-old female experienced disorientation, amnesia, and cortical blindness after coronary angiography (CAG).
• Initial CT scans were normal, but MRI revealed characteristic findings of CIN in the occipito-temporal and parietal regions.
• Symptoms resolved spontaneously within 72 hours.

Findings:

• The patient underwent a successful repeat CAG with a reduced contrast volume and pre-procedure hydrocortisone administration.
• Percutaneous coronary intervention (PCI) to the Left Anterior Descending artery (LAD) was completed without any recurrence of neurotoxicity.
• This suggests that careful management strategies can mitigate the risk of CIN recurrence.

Implications:

• Successful contrast re-challenge is feasible in patients with a history of CIN.
• Pre-medication with corticosteroids and dose reduction of contrast media are potential strategies to prevent recurrent CIN.
• This case highlights the importance of individualized patient assessment and tailored procedural planning in cardiac catheterization.