ReviewMedicine2025
Case report and literature review: Misdiagnoses of contrast encephalopathy as stroke.
Review in Medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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3 authors.
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Abstract
rationaleContrast-induced encephalopathy (CIE) is a rare complication following carotid artery stenting, often mimicking stroke symptoms such as focal neurological deficits. Its transient nature and reversibility necessitate differentiation from critical complications like cerebral hemorrhage or infarction, as management strategies differ substantially. This case underscores the diagnostic challenges and clinical implications of CIE in endovascular procedures. PATIENT CONCERNS: A 65-year-old woman with a history of cerebral infarction and prior carotid artery stenting presented with persistent numbness in her extremities for over 1 month. Post-carotid artery stenting, she developed acute slurred speech and right-sided limb weakness within 1 hour, raising concerns for stroke or procedural complications. DIAGNOSES: Emergency cranial computed tomography revealed left cerebral hemisphere swelling and linear hyperdensities, while magnetic resonance imaging demonstrated punctate diffusion-weighted imaging hyperintensities in the left parietal lobe. Temporal correlation of symptoms with iodixanol contrast administration (150 mL) supported a diagnosis of CIE, excluding acute infarction or hemorrhage.
interventionsImmediate management included antiplatelet therapy (tirofiban), thrombolysis (urokinase), corticosteroids (methylprednisolone), and antiedema agents (mannitol and albumin). Supportive care emphasized hydration and neurological monitoring. OUTCOMES: The patient exhibited progressive improvement, with complete resolution of speech and motor deficits by postoperative day 3. Neuroimaging abnormalities regressed, aligning with the transient nature of CIE. LESSONS: This case highlights the critical role of prompt neuroimaging to exclude life-threatening differentials and confirms CIE's reversibility with supportive care. Risk factors such as contrast volume and cerebral circulation dynamics warrant attention. Clinicians should exercise caution in readministering iodinated contrast to patients with prior CIE episodes.
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