Treatment of contrast induced encephalopathy: multicenter cohort study and proposed treatment algorithm

Contrast induced encephalopathy (CIE) is an increasingly recognized but uncommon complication of endovascular procedures. Despite increased reports, there is limited evidence to guide clinical management. We sought to identify commonly used treatments for CIE and propose management strategies to aid clinical decision making.

A retrospective multicenter study was conducted across 10 neurovascular centers in Australia. Cases were included based on previously proposed diagnostic criteria for CIE. Clinical features, treatments, and outcomes were extracted and analyzed. Descriptive statistics were used to characterize management strategies, and associations with clinical outcomes were assessed using Fisher's exact and χ² tests.

56 patients were identified (median age 65 years; 80.4% women). Common interventions included corticosteroids (66.1%), intravenous fluids (66.1%), and antiseizure medications (prophylactic 51.8% and therapeutic 12.5%). Half required intensive care admission for neurological monitoring. Complete recovery was achieved in 87.5% of cases. Corticosteroid administration was significantly associated with symptom resolution within 72 hours (OR 4.51, 95% CI 1.19 to 17.85, P=0.022), while intravenous fluids showed a non-significant trend toward shorter symptom duration (OR 2.25, 95% CI 0.64 to 8.15, P=0.170).

CIE generally carries a favorable prognosis. Corticosteroids appeared to shorten symptom duration and may be considered in management. Based on our findings and the existing literature, we propose a treatment algorithm to guide clinicians. Prospective validation is warranted.