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- W4313222571 abstract "Introduction: Contrast-induced encephalopathy (CIE) is a rare but well-known complication of intra-arterial contrast administration and presents with a variety of neurological deficits due to disruption of the blood-brain barrier and chemotoxic effect of hyperosmolar media. We present a case of CIE after administration of intravenous contrast for Computed Tomography Pulmonary Angiogram (CTPE). Description: A woman in her mid-70s with a history of COPD, presented with shortness of breath. She was diagnosed with multifocal pneumonia and started on IV antibiotics, IV steroids, and Bilevel positive pressure ventilation. A CTPE was done to rule out a pulmonary embolism during which she received 100cc of Isovue 370, (Iopamidol 76%), a low-osmolar, non-ionic, monomeric, iodine-based contrast agent. Within minutes of the contrast administration, the patient developed confusion and agitation with elevated blood pressure. Neurological evaluation revealed no gross deficits and bilateral mute plantar reflexes. Laboratory investigations were unchanged. CT brain within 2 hours of symptom onset revealed no intracranial abnormality. She was managed conservatively with IV fluids, neuro-checks, and blood pressure control, along with IV steroids. Her sensorium improved within 48 hours with supportive treatment. A repeat neuroimaging was not performed. She was discharged with the resolution of her respiratory symptoms. Discussion: CIE is associated with intraarterial contrast media but has been found to occur even after intravenous administration, reported only once in literature. The presentation is variable, ranging from headache to coma, with transient cortical blindness being most commonly identified. The diagnosis requires a high index of suspicion, and brain imaging is usually pathognomonic showing contrast enhancement in the cortical, subarachnoid, striatal spaces, or cerebral edema. However, cases in the absence of radiological signs have also been diagnosed. Typically, symptoms resolve within 48-72 hours and the disease runs a benign course, but there have been reported cases of persistent neurological deficits and fatal cerebral edema. Treatment is usually supportive with hydration and anticonvulsants, and occasional use of IV steroids and mannitol have reported favorable outcomes." @default.
- W4313222571 created "2023-01-06" @default.
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- W4313222571 date "2022-12-15" @default.
- W4313222571 modified "2023-09-27" @default.
- W4313222571 title "492: INTRAVENOUS CONTRAST-INDUCED ENCEPHALOPATHY: A CLINICAL CONUNDRUM" @default.
- W4313222571 doi "https://doi.org/10.1097/01.ccm.0000907696.88857.55" @default.
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