Iohexol
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Encephalopathy, contrast (iohexol) extravasation and contrast toxicity: case report An 82-year-old woman developed encephalopathy, contrast extravasation and contrast toxicity following administration of iohexol as a contrast media. The woman had a history of diabetic nephropathy, diabetes, hypertension, atrial fibrillation anticoagulated with acenocoumarol and stage IIIb-IVa chronic kidney disease. She was suffering from right hemiparesis and was receiving treatment for impaired speech emission. Upon her arrival, her INR was 1.89, BP was 150/92 and National Institutes of Health Stroke Scale (NIHSS) was 17. A multimodal CT showed extensive area of ischaemic penumbra in the territory of the left middle cerebral artery with occlusion in M1. Therefore, she underwent primary thrombectomy and achieved a complete recanalisation after insertion of a distal aspiration catheter. But, she exhibited no improvement with BP 226/100. Two hours after recanalisation, brain CT showed an contrast extravasation in the left hemisphere along with encephalopathy because of ruptured blood-brain barrier secondary to contrast toxicity (iohexol 350mg iodine/mL) [route, frequency, duration of treatment to reactions onsets not stated] and hypertensive crisis. Subsequently, she started developed generalised left hemispheric focal seizures. The woman was then treated with phenytoin and diazepam without recovery. Hence, a sedation-analgesia was performed and levetiracetam was added to the treatment regime. A brain CT was performed after 24 hours, which showed disappearance of contrast and few signs of swelling in the left hemisphere with no infarction. Additionally, several electroencephalograms ruled out seizures, so phenytoin was stopped. She was then extubated without any event. Eight days after onset, a repeat brain CT was performed, which did not show any infarction. She was then discharged asymptomatically (NIHSS: 0) on apixaban and levetiracetam was stopped. Aguirre C, et al. Contrast-induced encephalopathy possibly secondary to endothelial damage after successful mechanical thrombectomy. Neurologia 35: 336-338, No. 5, Jun 803499969 2020. Available from: URL: http://doi.org/10.1016/j.nrl.2018.02.004 [Spanish; summarised from a translation]
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Reactions 5 Sep 2020 No. 1820
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