Unilateral contrast-induced encephalopathy with contrast medium exudation: A case report

Area of Science:

• Neurology
• Radiology
• Critical Care Medicine

Background:

• Contrast-induced encephalopathy (CIE) is a rare, reversible neurological disorder following intravascular contrast agent administration.
• It can manifest with diverse neurological deficits and systemic symptoms, posing risks of irreversible damage if misdiagnosed or untreated, particularly in critically ill patients.

Observation:

• A middle-aged male developed progressive neurological decline, including altered consciousness, aphasia, and hemiparesis, hours after digital subtraction angiography.
• Initial CT scans were misleading, suggesting subarachnoid hemorrhage, but subsequent imaging revealed evolving brain swelling consistent with CIE.
• The patient experienced seizures, high fever, and signs of meningeal irritation, complicating the clinical picture.

Findings:

• Despite initial misdiagnosis, serial CT imaging and clinical correlation led to the diagnosis of CIE after excluding other conditions like subarachnoid hemorrhage and cerebrovascular embolism.
• Aggressive management including hydration, osmotic diuretics, and corticosteroids resulted in complete recovery without sequelae over 17 days.

Implications:

• CIE requires heightened clinical suspicion due to its potential for misdiagnosis and severe consequences.
• Timely and accurate diagnosis, followed by prompt, appropriate treatment, is essential for favorable patient outcomes.
• Careful consideration of risks and benefits is necessary before repeat contrast agent administration in patients with a history suggestive of CIE.