SHM Converge Scientific Abstract ePoster Gallery-Confusion After Contrasted Infusion

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This case report describes contrast-induced encephalopathy (CIE), a rare but important complication of intravascular contrast use that can cause transient confusion, focal neurologic deficits, seizures, or cortical blindness. The reported patient was a 76-year-old woman with hypertension, a recent left cerebellar hemorrhage requiring craniotomy, and a newly discovered 6.5 mm right middle cerebral artery aneurysm. She had been neurologically normal at baseline and underwent an elective diagnostic cerebral angiogram to further evaluate the aneurysm.<br /><br />During the procedure, she became agitated and could not tolerate the angiogram, so it was stopped early after right internal carotid artery contrast injections. Shortly afterward, she developed confusion, a right gaze preference, and left-sided hemiparesis. Her blood pressure and kidney function were acceptable, and emergent repeat angiographic assessment showed no stroke, major vessel occlusion, or vascular injury. Head CT also showed no new hemorrhage. The following day, repeat CT remained unchanged, and EEG demonstrated generalized encephalopathy without epileptiform activity.<br /><br />With no alternative cause identified, clinicians suspected CIE and treated her conservatively with close neurologic monitoring and continuous intravenous fluids. Over the next two days, her mental status returned to baseline and motor function improved significantly, though mild left arm weakness persisted. She was discharged to a rehabilitation facility with potential for full neurologic recovery. To prevent future exposure, iodinated contrast was documented as an allergy.<br /><br />The report emphasizes that CIE may follow different types of contrast media, but is often associated with localized injections. The proposed mechanism is osmotic disruption of the blood-brain barrier leading to direct neurotoxicity and cerebral edema. Recognizing CIE promptly is important to avoid unnecessary procedures or treatments, and prognosis is often favorable with supportive care.

Asset Subtitle

Jin Tao

Meta Tag

Author List Jin Tao, Luqman Baloch, Saagar Pamulapati, Vibhav Bansal

Category Clinical Vignettes

Concept Contrast-Induced Encephalopathy

Concept Encephalopathy

Concept Iodinated Contrast

Concept Diagnostic Cerebral Angiography

Concept Transient Cortical Blindness

Distinguished Non-Finalist

Presenter Organization MercyHealth

Presenting Author Jin Tao

Track Adult

Keywords

contrast-induced encephalopathy

CIE

iodinated contrast

cerebral angiography

neurologic deficits

confusion

hemiparesis

blood-brain barrier disruption

cerebral edema

supportive care

Contrast-Induced Encephalopathy

Encephalopathy

Iodinated Contrast

Diagnostic Cerebral Angiography

Transient Cortical Blindness