title: Acute ischemic stroke mimicking subarachnoid hemorrhage after coronary angioplasty.
abstract: Use of non-ionic contrast media (CM) in coronary arteriography has been reported to cause transient cortical blindness, confusion, amnesia and very rare focal deficits. We report a 69-year old patient with stable angina pectoris who underwent coronary angioplasty with stent placement due to in-stent thrombosis of the right coronary artery and developed stroke symptoms with radiological suspicion of subarachnoid hemorrhage. No vascular malformations were detected on CT cerebral angiography. Dual antiplatelet treatment was continued. Complete neurological recovery was observed within 48 hours post angiography. As observed with repeated CT scans, sulcal hyperdensities mostly faded after 24 hours and totally disappeared within 7 days when she was discharged home. Our case shows transient neurological symptoms and rapid disappearing of sulcal hyperdensities, suggesting temporary blood brain barrier disruption, consequential cerebral infarction and contrast media extravasation as the main mechanisms which allowed us to treat the patient with dual antiplatelet treatment.
authors.affiliation: .
authors.forename: Ana
authors.initials: A
authors.lastname: Piršić
authors.affiliation: .
authors.forename: Tomislav
authors.initials: T
authors.lastname: Šipić
authors.affiliation: .
authors.forename: Krešimir
authors.initials: K
authors.lastname: Štambuk
authors.affiliation: .
authors.forename: Hrvoje
authors.initials: H
authors.lastname: Budinčević
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000601:surgery*; D017130:Angioplasty / Q000009:adverse effects*; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy; D002533:Cerebral Angiography; D003287:Contrast Media / Q000009:adverse effects*; D003937:Diagnosis, Differential; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D010975:Platelet Aggregation Inhibitors
keywords: blood-brain barrier; cerebral infarction; contrast media; neurotoxicity syndromes; subarachnoid hemorrhage