SHM Converge Scientific Abstract ePoster Gallery-Confusion After Computed Tomograpy: A Dystonic Reaction to Iodinated Contrast

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This case describes a 73-year-old woman with hypertension, peripheral artery disease, and prior intravenous drug use who developed two episodes of acute altered mental status after receiving iodinated contrast for CT imaging. She initially presented to the emergency department with right leg pain, and a CT angiogram was performed to assess for vascular complications after recent stenting. Shortly after contrast administration, she became unresponsive with abnormal facial movements and required intubation for airway protection. Brain CT and MRI were normal, infectious workup was negative, and she gradually returned to baseline. She was started on Keppra for possible seizure but later improved and it was discontinued.<br /><br />One week later, during a subsequent hospitalization for flank pain and hydroureteronephrosis, she underwent another contrast-enhanced CT and again developed acute confusion and abnormal movements, including myoclonic jerks, eye fluttering, lip smacking, and posturing. Stroke and seizure were considered but imaging was again negative, and continuous EEG showed moderate diffuse encephalopathy. She improved over three days and returned to her neurologic baseline.<br /><br />The authors propose contrast-induced neurotoxicity (CIN) as the likely explanation. Iodinated contrast media are usually safe, but rare physiologic adverse effects include neurotoxicity, thought to result from blood-brain barrier disruption due to the hyperosmolar and chemotoxic effects of contrast. CIN can present with altered mental status, seizures, or focal neurologic deficits, and dystonic reactions are an especially rare manifestation.<br /><br />The patient later tolerated iodinated contrast during a nephrostomy procedure after premedication with prednisone and diphenhydramine, with no recurrence of neurologic symptoms. The report emphasizes that CIN should be considered in patients who develop new neurologic symptoms after contrast exposure, and that premedication may help in patients with prior neurologic reactions.

Asset Subtitle

Katherine M. Cooper

Meta Tag

Author List Katherine M. Cooper, Maria I. Hincapie Marquez, Sierra Anderson

Category Clinical Vignettes

Concept Iodinated Contrast

Concept Encephalopathy

Concept Allergic-like Reaction

Concept Physiologic Reaction

Concept Neurotoxicity

Distinguished Non-Finalist

Presenter Organization University of Massachusetts Medical School

Presenting Author Katherine M. Cooper

Track Adult

Keywords

contrast-induced neurotoxicity

iodinated contrast

altered mental status

seizure-like activity

myoclonic jerks

diffuse encephalopathy

computed tomography angiography

blood-brain barrier disruption

dystonic reaction

premedication

Iodinated Contrast

Encephalopathy

Allergic-like Reaction

Physiologic Reaction

Neurotoxicity