title: An atypical case of contrast-induced encephalopathy after carotid artery stenting.
abstract: Neurotoxicity caused by contrast agents is a rare and less known complication of percutaneous carotid and coronary interventions. Radiological signs, such as cortical enhancement and brain edema, are of utmost importance in diagnosis. A 70-year-old female patient underwent left carotid artery stenting to treat a post-traumatic asymptomatic carotid dissection. Three hours after intervention, a mild aphasia developed with no brain alteration on diffusion-weighted magnetic resonance imaging (DW-MRI). Twelve hours after intervention, symptoms worsened but a new DW-MRI scan showed no pathological findings. Since a contrast-induced encephalopathy was diagnosed, fluid administration was raised to 2 mL/kg/h and the neurological status progressively improved. In the following three days, neurological deficit slowly regressed. Two weeks after intervention, aphasia had disappeared and a further cerebral DW-MRI scan detected no brain alteration. Typical radiological signs are described in association to contrast encephalopathy. Nevertheless, vascular interventional physicians should be well aware of this condition also when those signs are lacking.
authors.affiliation: Department 'Paride Stefanini', Policlicnico Umberto I, 'Sapienza' University, Rome, Italy. dmenna@hotmail.it
authors.forename: D
authors.initials: D
authors.lastname: Menna
authors.forename: L
authors.initials: L
authors.lastname: Capoccia
authors.forename: A R
authors.initials: AR
authors.lastname: Rizzo
authors.forename: E
authors.initials: E
authors.lastname: Sbarigia
authors.forename: F
authors.initials: F
authors.lastname: Speziale
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation*; D001037:Aphasia / Q000139:chemically induced; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000628:therapy*; D003287:Contrast Media / Q000009:adverse effects*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007479:Iopamidol / Q000009:adverse effects / Q000031:analogs & derivatives*; D009460:Neurologic Examination; D020258:Neurotoxicity Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D015641:Radiography, Interventional / Q000009:adverse effects*; D020127:Recovery of Function; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol