Abstract Details

Title A Case of Contrast-Induced Encephalopathy in The Setting of Acute Stroke Thrombolysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 105

Objective To present a case of contrast-induced encephalopathy (CIE) after IV thrombolysis (IVT) for acute ischemic stroke (AIS).

Background CIE is an acute and reversible neurological deterioration within minutes to hours of contrast administration. It can present with any focal deficits (e.g. aphasia, weakness, or sensory changes) or seizures, especially in patients with end-stage renal disease (ESRD). CIE is well-described after cerebral and coronary angiography, but not frequently reported after IVT for AIS.

Design/Methods A case report.

Results An octogenarian man with ESRD presented as a stroke-alert with acute left-sided weakness. NIHSS was 9 concerning for a partial right ACA/MCA syndrome. Brain CT and CTP, and head and neck CTA were unremarkable except for a small area of increased Tmax > 4s in the distal right ACA territory. IVT was started. A repeat CT head showed faint hyperattenuation in the right frontal region with sulcal effacement. Four hours later, he started having left upper extremity myoclonus progressing to generalized seizures. Repeat CT head revealed more conspicuous hyperdensity with swelling and sulcal effacement concerning for hemorrhagic transformation. On Dual-energy CT, this was favored to be contrast staining. Brain MRI showed gyriform restricted diffusion in the right superior central gyrus and right precentral gyrus representing post-ictal changes, without any evidence of hemorrhage on GRE. Follow-up CT scan at 24 hours showed resolving hyperattenuation in the aforementioned areas. The patient had no persistent deficits or seizures on follow up after 6 months.

Conclusions CIE can complicate IVT, especially in patients with ESRD. Conventional CT scans will show hyperattenuation and edema mimicking hemorrhagic transformation, hence triggering IVT reversal and limiting its benefits. Neurologists should be vigilant about this entity and consider Dual-Energy CT scans to differentiate contrast staining from hemorrhagic transformation.

Authors/Disclosures
Qasem N. Alshaer, MD (University of Iowa) PRESENTER	Dr. Alshaer has nothing to disclose.
Zaid R. Najdawi, MD (University of Nebraska Medical Center)	Dr. Najdawi has nothing to disclose.
Ryan Peterson (Emory University School of Medicine)	Ryan Peterson has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Flaherty Sensabaugh Bonasso.
Nirav Bhatt, MD (University of Pittsburgh)	Dr. Bhatt has nothing to disclose.

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