Journal article
Clinical and Imaging Features of Contrast-Induced Neurotoxicity After Neurointerventional Surgery
World neurosurgery, Vol.142, pp.e316-e324
10/2020
DOI: 10.1016/j.wneu.2020.06.218
PMID: 32634632
Abstract
Contrast-induced neurotoxicity (CIN) is an infrequent complication of endovascular procedures, and its understanding remains poor. We aimed to study and characterize the clinical and imaging features of a case series of CIN after neurointerventional surgery.
We reviewed all neuroendovascular consecutive procedures from September 2014 to November 2018. CIN was defined as new onset of neurologic deficits that occurred postoperatively after excluding other conditions. All demographic, clinical, procedural, and radiologic data were retrospectively analyzed and collected.
Eleven cases of CIN in 1587 patients were identified out of 2510 procedures. The median age was 76 years (interquartile range [IQR], 65–81). The most common comorbidity was hypertension (82%). Median procedure time was 100 minutes (IQR, 80–130.5 minutes). All patients showed wide variability in intraprocedural blood pressure (BP) recordings with fluctuations from the baseline BP. Systolic BP ranged from 83 mm Hg below the patient baseline to 80 mm Hg above baseline. The median symptom onset was 4 hours (IQR, 0.8–9.5 hours). The CIN signs and symptoms presented gradually, initially with encephalopathy and later with focal signs. All patients had an initial computed tomography scan, which showed ipsilateral cerebral edema in 82% of patients. Two had contrast enhancement. Complete resolution of CIN symptoms was obtained in a median time of 3 days (IQR, 2.5–3 days).
CIN should be considered in the context of the progressive onset of neurologic deficits after neuroendovascular procedures. A distinct imaging pattern of ipsilateral hemisphere edema in the absence of ischemia is usually identified. Variability in procedural BP might be a predisposing factor.
Details
- Title: Subtitle
- Clinical and Imaging Features of Contrast-Induced Neurotoxicity After Neurointerventional Surgery
- Creators
- Cynthia B Zevallos - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USASudeepta Dandapat - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USASameer Ansari - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAMudassir Farooqui - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USADarko Quispe-Orozco - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAAlan Mendez-Ruiz - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAColin Derdeyn - Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USADavid Hasan - Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USAEdgar A Samaniego - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USASantiago Ortega-Gutierrez - Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Resource Type
- Journal article
- Publication Details
- World neurosurgery, Vol.142, pp.e316-e324
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.wneu.2020.06.218
- PMID
- 32634632
- ISSN
- 1878-8750
- eISSN
- 1878-8769
- Language
- English
- Date published
- 10/2020
- Academic Unit
- Roy J. Carver Department of Biomedical Engineering; Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology
- Record Identifier
- 9984070000602771
Metrics
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