Contrast-induced encephalopathy mimicking total anterior circulation stroke: a case report and review of the literature
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Contrast-induced encephalopathy mimicking total anterior circulation stroke: a case report and review of the literature Martina Vigano’ 1 & Vittorio Mantero 1 & Paola Basilico 1 & Christian Cordano 2 & Davide Sangalli 1 & Paolo Reganati 3 & Alessandro Lunghi 3 & Andrea Rigamonti 1 & Andrea Salmaggi 1 Received: 22 June 2020 / Accepted: 17 October 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Introduction Contrast-induced encephalopathy is a rare and usually reversible entity due to the administration of iodinated contrast. Clinical manifestations include cortical blindness, encephalopathy, seizures and focal neurological deficits. Methods We report the case of a 56-year-old woman who developed global aphasia and right hemiplegia after a cerebral angiography performed for a subarachnoid haemorrhage. A prompt brain MRI resulted negative, while CT scan revealed left cerebral oedema with the cerebral sulci effacement. Complete recovery was observed in 10 days. Discussion Diagnosis of contrast-induced encephalopathy requires a temporal correlation between neurological dysfunction and administration of iodinated contrast. Usually, the symptomatology is transient with a full recovery within 48–72 h. The most common symptom is cortical blindness, while other symptoms have been rarely reported. Only 20 cases previously reported global aphasia and/or hemiplegia or mimed anterior circulation strokes. Prompt brain neuroimaging is essential in order to exclude an alternative diagnosis that requires a distinct therapeutic approach. Keywords Contrast-induced encephalopathy . Iodinated contrast . Reversible encephalopathy . Stroke mimics . Stroke chameleons
Introduction Contrast-induced encephalopathy (CIE) is a rare, acute and usually reversible neurological entity associated with intraarterial administration of iodinated contrast. Risk factors seem to be hypertension and renal failure. Clinical manifestations include cortical blindness, encephalopathy, seizures and focal neurological deficits. In most reported cases, the symptoms are reversible and fatal encephalopathy has been rarely reported [1].
* Vittorio Mantero [email protected] 1
Neurological Department, “A. Manzoni” Hospital, ASST Lecco, Via dell’Eremo 9/11, 23900 Lecco, Italy
2
UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
3
Neuroradiological Unit, “A. Manzoni” Hospital, ASST Lecco, Lecco, Italy
Herein, we describe a patient who suffered from longlasting but fully reversible hemiplegia and global aphasia after a brain angiography.
Case report A 56-year-old right-handed woman has admitted to our emergency department for acute onset of intense headache which started in the previous 2 days. She had a history of migraine, renal colic, smoking and previous heroin abuse 20 years earlier. The brain CT scan showed a small interhemispheric posterior-left parafalcine subarachnoid haemorrhage. Cerebral angiography showed two small aneurysms i
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