title: Severe encephalopathy following cerebral arteriogram in a patient with end-stage renal disease.
abstract: Disruption of blood brain barrier (BBB) with subsequent subarachnoid contrast extravasation and cerebral edema is a rare complication of intra-arterial contrast administration. We report a patient with end-stage renal disease (ESRD) who developed such a complication. A 63-year-old man with a history of left orbital apex syndrome on hemodialysis (HD) was admitted with massive epistaxis. A pseudo-aneurysm of the left internal carotid artery (ICA) required a cerebral arteriogram with coil embolization; a total of 910 ml of isosmolar intra-arterial contrast was used. Shortly thereafter, the patient developed severe alteration in his mental status. A CT study without contrast of the head showed bilateral subarachnoid hyper-attenuation with diffuse cerebral edema consistent with contrast-induced encephalopathy syndrome. The patient was urgently and repetitively dialyzed to remove the contrast leading to a remarkable improvement in his mental status and resolution of both subarachnoid hyper-attenuation and brain edema. The large volume of intra-arterial contrast that may be required in neurologic interventional procedures is occasionally associated with breakdown of BBB leading to subarachnoid accumulation and cerebral edema resulting in a severe encephalopathy syndrome. Hemodialysis seems particularly well suited for the patient who has renal failure in whom this syndrome develops.
authors: Renal Section, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, USA.
authors: Jingyin
authors: J
authors: Yan
authors: Venkat
authors: V
authors: Ramanathan
mesh_terms: D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000628:therapy*; D001812:Blood-Brain Barrier; D001929:Brain Edema / Q000139:chemically induced*; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002533:Cerebral Angiography / Q000009:adverse effects*; D003287:Contrast Media / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic; D005119:Extravasation of Diagnostic and Therapeutic Materials; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media