Application of spectral CT in the diagnosis of contrast encephalopathy following carotid artery stenting: a case report
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CASE REPORT
Open Access
Application of spectral CT in the diagnosis of contrast encephalopathy following carotid artery stenting: a case report Qiuhong Jiang1, Liming Shu2 and Hua Hong1*
Abstract Background: Contrast encephalopathy is a rare complication of carotid artery stenting (CAS). Contrast encephalopathy is a diagnosis of exclusion that often needs to be distinguished from high perfusion syndrome, cerebral haemorrhage, subarachnoid haemorrhage (SAH), cerebral infarction and so on. Case presentation: In this study, we report on a 70-year-old man who was admitted to the hospital with transient ischaemic attacks presenting paroxysmal weakness of limbs in the previous 2 years. He had severe stenosis of the left internal carotid artery diagnosed by digital subtraction angiography (DSA) and underwent CAS. Two hours after the operation, the patient developed paralysis of the right upper limb, unclear speech, fever and restlessness. Emergency skull computed tomography (CT) showed swelling and a linear high-density area in the left cerebral hemisphere. To clarify the components of this high-density area in the traditional CT, the patient had spectral CT, which made the diagnosis of the leakage of contrast clear. After 1 week of supportive treatment, the patient improved. Conclusions: Spectral CT can easily distinguish the components of high-density areas on traditional CT, which is haemorrhage, calcification or iodine contrast leakage. Therefore, spectral CT is worth consideration for the differential diagnosis of complications of vascular intervention. Keywords: Contrast encephalopathy, Carotid artery stenting, Spectral CT, Case report
Background Common complications after carotid artery stenting (CAS) include hyperperfusion syndrome, plaque detachment and embolism, cerebral haemorrhage, subarachnoid haemorrhage (SAH) or infarction [1]. Contrast encephalopathy is a rare complication of CAS [1, 2]. Its symptoms are similar to stroke, including cortical blindness, speech insufficiency, seizures, restlessness, and focal neurological deficits [3, 4], which makes it * Correspondence: [email protected] 1 Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University; Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, No.58 Zhongshan Road 2, Guangzhou 510080, China Full list of author information is available at the end of the article
difficult to distinguish it from more common complications, such as cerebral haemorrhage (SAH), infarction, and hyperperfusion syndrome [5, 6]. Here, we present the diagnosis of an unusual case of contrast encephalopathy following CAS by using spectral computed tomography (CT).
Case presentation A 70-year-old male was admitted to the hospital on November 7, 2019 with transient ischaemic attacks presenting paroxysmal weakness of the limbs in the previous 2 years. He had a past medical history of diabetes and right inguinal surgery in 2018. On physical examination, hi
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