BÁO CÁO CA LÂM SÀNG: NGỘ ĐỘC NÃO DO THUỐC CẢN QUANG SAU CAN THIỆP MẠCH NÃO

Abstract

Contrast-induced encephalopathy (CIE) following endovascular procedures using iodinated contrast media is a rare complication (0.3 - 1%), often clinically mimicking acute stroke. This case report involves a 66-year-old female patient with a 7 × 4mm anterior communicating artery aneurysm, treated with digital subtraction angiography (DSA) stenting using Ultravist 300 (250mL), with normal eGFR. Post-procedure, the patient developed decreased consciousness, right hemiparesis, aphasia, and generalised seizures. Multimodal magnetic resonance imaging (MRI) showed cortical hyperintensity on DWI/FLAIR, no clear ADC diffusion restriction, no hemorrhage on SWI, no intracranial arterial stenosis/occlusion on MRA, and symmetric cerebral perfusion, suggestive of stroke-mimicking CIE. The patient received supportive treatment: Fluid resuscitation, corticosteroids, mannitol, and antiepileptics. Post-treatment, the patient fully recovered without neurological sequelae. Thus, CIE should be considered after DSA even with normal renal function; multimodal MRI is key for differential diagnosis, avoiding unnecessary interventions.