Irreversible fatal contrast-induced encephalopathy: a case report

Abstract Background: Contrast-induced encephalopathy (CIE) is a well known complication of iodinated contrast agents during angiography and vascular interventions. It can be manifested as hemiparesis, cortical blindness, speech changes, parkinsonism, confusion, seizure, and coma etc. Most of the reported CIE cases were transient and reversible. Irreversible fatal CIE cases were rarely reported. All the fatal CIE cases reported before used the ionic high osmolar contrast agents. Here we document a heretofore unreported fatal CIE after digital subtraction angiography（DSA）using iopamidol, which is a type of non-ionic monomer low osmolar contrast agent. Case presentation: A 71-year-old woman was admitted to our neurology department for paroxysmal buzzing of the brain. The cerebral magnetic resonance angiography (MRA) indicated arteriosclerosis of cerebral arteries and stenosis of bilateral middle cerebral arteries. Then she took DSA for further diagnosis. Total amount of iopamidol used during the procedure was 110 ml. The patient manifested headache during the procedure, and then had dizziness with nausea and vomiting. Although the patient was treated with anti-edema drugs, the deterioration was continuous, she gradually became coma state, and suffered irreversible fatal cerebral edema, which had been confirmed by cerebral computed tomography (CT) scans. At last, the patient died 56 days after the procedure due to irreversible fatal cerebral edema. Conclusions: This report indicates that iopamidol induced encephalopathy may not always have a benign outcome and can cause irreversible fatal cerebral edema. Keywords: Digital subtraction angiography; iodinated contrast agents; complications; contrast-induced encephalopathy