„Unexpected” coronarography complication: contrast – induced encephalopathy

Introduction: Coronary angiography and coronary angioplasty are very extremely valuable investigations – „gold standard“ for the investigation and, respectively, the treatment of coronary atherosclerotic disease. The overall risks of these maneuvers are known, depending on patient’s profile, cardiovascular status and comple-xity of the procedure; complications are rare, being, generally, represented by vascular or haemodynami-cal complications, nephropathy or alergies induced by contrast agents and rarely stroke, myocardial infarction or death. Besides the complications known and menti-oned by specialized guides, in practice we sometimes encounter „unexpected“ complications of various dia-gnostic or therapeutic maneuvers.

Methods: We present the case of a 81-year-old diabe-tic patient with angina pectoris of effort and rest, with significant ST changes on ECG in the crisis and on ECG stress test, with persistent symptomatology under maximum anti-ischemic treatment, which is why co-ronarography was performed, which reveals extremely tortuous coronaries, but no significant lesions.

Results: 3 hours after the investigation, the patient suddenly develops intense headache and immediately sensitive aphasia. The neurological examination reveals aphasia, with no other neurological focal signs and asks for CT and then cerebral MR, which excludes acute is-chemic or hemorrhagic stroke. Thus, the diagnosis of contrast-induced encephalopathy is established and treatment with osmotic diuretic, hydro-electrolytic correction, acid-base correction, glycemic control and BP control are done. After 72 hours, symptomatic re-mission of symptoms is recorded, with restitution ad integrum.

Conclusions: Contrast-induced encephalopathy is a very rare, but potentially severe complication of co-ronary angiography, with incompletely elucidated mechanisms, requiring a rapid differential diagnosis with ischemic or hemorrhagic stroke. It does not de-pend on the type or osmolarity of the contrast substan-ce, the risk factors are not well known, and may result in death, coma, partial sequelae, or total recovery.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)