title: Contrast-induced neurotoxicity after coronary angiography.
abstract: BACKGROUND
  Contrast-induced neurotoxicity (CIN) is a very rare complication of coronary angiography. Clinical presentations include encephalopathy, seizures, cortical blindness, and focal neurological deficits. An inherent difficulty in understanding the natural history of the condition as well as its risk factors and prognosis is the rarity of its occurrence. To date, there are only case reports published on this complication.
  
  
  METHODS
  This was a retrospective analysis of 9 patients with CIN (8 men, 1 woman; mean age, 64.6 ± 7.8 years; range, 47-72 years) and coronary artery disease who were administered iopromide contrast agent.
  
  
  RESULTS
  In the last 3 years, we diagnosed 9 patients with CIN. Of these, 8 patients (89 %) had hypertension. The clinical presentations of the patients were different on admission: 6 patients had acute coronary syndrome and 3 patients had stable angina pectoris. One patient had history of previous contrast agent exposure. All patients underwent coronary angiography with a low-osmolar nonionic monomer contrast agent (iopromide; Ultravist®-300, Bayer Healthcare). The mean volume of contrast injected was 177 ± 58 ml. The mean time between contrast agent administration and clinical symptoms was 100 ± 71 min (range, 30-240 min). While in 5 of the patients (56 %) the clinical sign of CIN was confusion, 2 had ophthalmoplegia, 1 had cerebellar dysfunction, and 1 had monoplegia. In 8 of 9 patients (89 %), neurological symptoms resolved after giving supportive medication and hydration. Only 1 female patient, who had bilateral ophthalmoplegia, did not recover. Neurological recovery occurred at a mean time of 14.2 ± 6.7 h (range, 8-30 h).
  
  
  CONCLUSIONS
  CIN is a very rare condition. Advanced age, male gender, and hypertension are the greatest risk factors for CIN. Although the prognosis of CIN is benign, it can potentially cause permanent neurological deficits or death. We found that patients with ophthalmic involvement had a higher propensity for persistent deficit. On the basis of the current data, we propose 170 ml as the maximal recommended dose for coronary procedures.
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, Centro Gallucci, University of Padua, Via Giustiniani 2, 35128, Padua, Italy, gonenckocabay@yahoo.com.
authors.forename: G
authors.initials: G
authors.lastname: Kocabay
authors.forename: C Y
authors.initials: CY
authors.lastname: Karabay
authors.forename: A
authors.initials: A
authors.lastname: Kalayci
authors.forename: T
authors.initials: T
authors.lastname: Akgun
authors.forename: A
authors.initials: A
authors.lastname: Guler
authors.forename: V
authors.initials: V
authors.lastname: Oduncu
authors.forename: I H
authors.initials: IH
authors.lastname: Tanboga
authors.forename: A
authors.initials: A
authors.lastname: Izgi
authors.forename: C
authors.initials: C
authors.lastname: Kirma
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000000981:diagnostic imaging*; D000368:Aged; D003287:Contrast Media / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007472:Iohexol / Q000009:adverse effects / Q000031:analogs & derivatives*; D008297:Male; D020258:Neurotoxicity Syndromes / Q000175:diagnosis* / Q000209:etiology*; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media; D007472:Iohexol; C038192:iopromide