It is not blood everything that glitters

A 75 year-old male with cardiovascular risk factors developed acute dysarthric language and right facial paralysis after percutaneous coronary intervention (diagnosis of acute myocardial infarction). Due to the clinical presentation and the potential risk known of arterial embolism after these kind of procedures, the stroke code was activated.A non-contrast CT showed a thickening and hyperdensity of the cortex of some left frontal gyrus, without further significant findings. A CT performed 15 hours later demonstrated a significant improvement and a clinical examination at 72 hours showed absence of neurological symptoms.

Contrast-induced encephalopathy Contrast-induced encephalopathy is a rare adverse reaction after a coronary angiography. This complication is transitory (24 to 72 hours) and it can be presented as focal neurological deficits, seizures, cortical blindness and encephalopathy. The mechanism by this pathology occurs is not well known. Different etiologies have been proposed as direct chemotoxic effects and hyperosmolarity, endothelin damage of the hematoencephalic barrier or vasospasm. The most frequent etiology of a neurological episode in a patient following cardiac catheterization is ischemia. Also, subarachnoid hemorrhage and extravasation of contrast should be considered in the differential diagnosis, more frequent entities in clinical practice. The importance of the suspicion of contrast-induced encephalopathy is due to its good prognosis and to avoid iatrogenic treatment, since it only needs support measures.

Contrast-induced encephalopathy must be considered if it’s seen hyperdensity at CT subsequent to coronarography and the neurological clinic resolves in a period less than 72 hours.

- Morales-Casado MI, Muñoz-Escudero F, García-Benassi JM, Almansa-Castillo R, Segundo-Rodríguez JC, GarridoRobres JA, el al. Encefalopatía por contraste iodado: una patología que se debe tener en cuenta en el desarrollo