Dual-Energy CT to Diagnose Pseudoedema in Contrast-Induced Encephalopathy Following Cerebral Angiography

Gabriel L. Pagani-Estévez, Deena Nasr, Waleed Brinjikji, Avital Perry, Jennifer E. Fugate

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Contrast-induced encephalopathy (CIE) is a syndrome that may be clinically unrecognized and misdiagnosed as cerebral edema. Methods: Case report and review. Results: A 72-year-old woman was admitted for elective endovascular embolization of a 10-mm left anterior communicating artery aneurysm. One hour post-procedure, she acutely developed global aphasia. Emergent head computed tomography (CT) and computed tomography-angiography (CTA) showed high attenuation of the left hemispheric subarachnoid spaces interpreted as hemispheric edema; emergent magnetic resonance imaging revealed left hemispheric punctate infarcts. At 12 h, she developed right hemiparesis and encephalopathy. Repeat CTA and CT perfusion revealed decreased left hemisphere cerebral blood flow and diminutive caliber of distal left middle cerebral artery territory vasculature. Repeated angiography with intra-arterial verapamil and systemic blood pressure augmentation were performed for presumed vasospasm. At 20 h, head CT was concerning for worsening left hemispheric edema, but dual-energy, iodine-subtracting sequences revealed significant contrast extravasation contributing to the appearance of sulcal effacement but without actual edema. Out of concern for blood–brain barrier breakdown from CIE, pressor augmentation was discontinued and the patient gradually improved to full neurological recovery within 72 h of symptom onset. Conclusions: Our case is the first known to report the use of dual-energy, iodine-subtracting CT as a diagnostic tool in differentiating between cerebral edema and pseudoedema in CIE.

Original languageEnglish (US)
Pages (from-to)261-264
Number of pages4
JournalNeurocritical care
Volume27
Issue number2
DOIs
StatePublished - Oct 1 2017

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Cerebral Angiography
Brain Diseases
Tomography
Edema
Brain Edema
Iodine
Cerebrovascular Circulation
Head
Subarachnoid Space
Aphasia
Middle Cerebral Artery
Intracranial Aneurysm
Paresis
Verapamil
Diagnostic Errors
Angiography
Perfusion
Magnetic Resonance Imaging
Blood Pressure
Computed Tomography Angiography

Keywords

  • Contrast
  • Encephalopathy
  • Pseudoedema

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Dual-Energy CT to Diagnose Pseudoedema in Contrast-Induced Encephalopathy Following Cerebral Angiography. / Pagani-Estévez, Gabriel L.; Nasr, Deena; Brinjikji, Waleed; Perry, Avital; Fugate, Jennifer E.

In: Neurocritical care, Vol. 27, No. 2, 01.10.2017, p. 261-264.

Research output: Contribution to journalArticle

Pagani-Estévez, Gabriel L. ; Nasr, Deena ; Brinjikji, Waleed ; Perry, Avital ; Fugate, Jennifer E. / Dual-Energy CT to Diagnose Pseudoedema in Contrast-Induced Encephalopathy Following Cerebral Angiography. In: Neurocritical care. 2017 ; Vol. 27, No. 2. pp. 261-264.
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