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 manifest as hemiparesis, cortical blindness, speech changes, Parkinsonism, confusion, seizure, and coma. Most of the reported CIE cases have been transient and reversible. Irreversible fatal CIE cases have been rarely reported. All the fatal CIE cases reported involved the use of 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 Department of Neurology for paroxysmal buzzing of the brain. The cerebral magnetic resonance angiography (MRA) indicated the presence of arteriosclerosis of the cerebral arteries and bilateral stenosis of the middle cerebral arteries. The patient underwent DSA for further diagnostic work-up. The total amount of iopamidol used during the procedure was 110 ml. The patient experienced headache during the procedure, followed by dizziness with nausea and vomiting. Although the patient was treated with anti-oedema drugs, her deterioration was continuous. She gradually became comatose and suffered irreversible fatal cerebral oedema, which was confirmed by cerebral computed tomography (CT). Finally, the patient died 56 days after the procedure due to irreversible fatal cerebral oedema. Conclusions: This report documents that iopamidol-induced encephalopathy may not always have a benign outcome and can result in irreversible fatal cerebral oedema.