Presentation
Post ACA aneurysm coiling with rapidly developing expressive and receptive aphasia. No motor, sensory or cranial nerve deficits.
Patient Data
New diffuse edema of the left cerebral hemisphere, predominately in the left MCA territory with generalized sulcal effacement and slight cortical and subarachnoid fluid hyperattenuation.
Follow up MRI performed five days post-angiogram demonstrates complete resolution of left hemisphere contrast-induced edema. A tiny number of thromboembolic events are also visible, which resolved on further imaging.
Case Discussion
Contrast-induced neurotoxicity is a rare adverse reaction to iodinated contrast agents used for angiography and endovascular interventions. This is hypothesized to occur through temporary disruption of the blood brain barrier. Clinical presentations include encephalopathy, transient cortical blindness, aphasia and motor weakness. Imaging findings include cortical and/or subcortical enhancement, cerebral edema and hyperdensity in the subarachnoid space or parenchyma without signs of ischemia. Most patients exhibit spontaneous and rapid clinical recovery within 24-48 hours.
In this case, follow-up imaging revealed complete resolution of contrast-induced edema. The patient made a full clinical recovery within a few days.