Reactions 1680, p188 - 2 Dec 2017 Encephalopathy and hemiparesis: case report A 72-year-old woman developed encephalopathy and right hemiparesis during treatment with iohexol [Omnipaque 300; dosage, route; time to reaction onset not clearly stated]. The woman had a history of type 2 diabetes mellitus and a 10mm anterior communicating artery aneurysm on the left side. SHe underwent an elective endovascular flow-diverter embolisation of the aneurysm. One hour later, she developed global aphasia. Subsequently, an emergent CT scan and a CT angiography using iohexol as a contrast medium were performed, which showed normal vasculature but a high attenuation of the left hemispheric subarachnoid space interpreted as hemispheric oedema. An emergent MRI revealed scattered, punctate infarcts in the left middle cerebral artery region. Twelve hours after the embolisation procedure, she developed right hemiparesis and encephalopathy that worsened gradually and peaked at 24 hours. Subsequently, a repeat CT angiography revealed a minute calibre of the vasculature in the region of the distal left cerebral artery. A perfusion CT scan showed a reduced left hemispheric cerebral blood flow with preservation of the cerebral blood volume. Thereafter, the woman underwent an emergency angiography and was treated with verapamil for the vasospasm. Her BP was augmented using phenylephrine to 160mm Hg with no change in the calibre of the vasculature in the region of the distal left cerebral artery on a repeat CT angiography. An electroencephalography revealed a focal persistent delta of moderate-high amplitude on the left side, predominantly over the fronto-temporal region of the head. Her severe neurological deficits progressive worsened even after 24 hours following the embolisation procedure. A subsequent non-contrast CT showed worsening of the left hemispheric oedema. Thereafter, a dual energy iodine subtracting sequencing revealed iohexol contrast extravasation that contributed to the sulcal effacement appearance with the presence of actual brain oedema. Therefore, she was diagnosed with contrast-induced encephalopathy and hemiparesis due to iohexol. Her vasopressor augmentation was withdrawn. Seventy-two hours after the onset of the symptoms, she had a complete neurologic recovery. Author comment: "We report a case of [contrast-induced encephalopathy] in which we used a dual energy CT scan to make the diagnosis." "At 12 h, she developed right hemiparesis and encephalopathy." Pagani-Estevez GL, et al. Dual-Energy CT to Diagnose Pseudoedema in Contrast- Induced Encephalopathy Following Cerebral Angiography. Neurocritical Care 27: 261-264, No. 2, Oct 2017. Available from: URL: http://doi.org/10.1007/ s12028-017-0394-7 - USA 803284095 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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