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  4. Contrast-medium injury of spinal cord after cerebral angiography using nonionic contrast agents: A case report and literature review

Contrast-medium injury of spinal cord after cerebral angiography using nonionic contrast agents: A case report and literature review

Medicine, 2023 · DOI: 10.1097/MD.0000000000036630 · Published: December 1, 2023

NeuroimagingNeurologyResearch Methodology & Design

Simple Explanation

This case report describes a rare complication following cerebral angiography called contrast-induced spinal cord injury (CIS). The patient, a 41-year-old male, developed quadriplegia after undergoing the procedure. The doctors initially suspected contrast-induced encephalopathy (CIE) due to the patient's symptoms and imaging findings. However, the later development of paralysis and further MRI scans revealed CIS. The patient was treated with medications and rehabilitation, which led to improvement in his neurological symptoms. This case highlights the importance of considering CIS even when using modern contrast agents.

Study Duration
Not specified
Participants
A 41-year-old male
Evidence Level
Level 4; Case Report and Literature Review

Key Findings

  • 1
    A patient developed contrast-induced spinal cord injury (CIS) following cerebral angiography using a nonionic contrast agent (Ioversol). This is a rare occurrence, as CIS is more commonly associated with ionic contrast agents.
  • 2
    The patient initially presented with symptoms of contrast-induced encephalopathy (CIE), which resolved, but later developed quadriplegia and paresthesia, leading to the diagnosis of CIS.
  • 3
    MRI findings revealed a hyperintense signal in the spinal cord, supporting the diagnosis of CIS. The patient's condition improved with treatment including methylprednisolone and rehabilitation.

Research Summary

This case report details an instance of contrast-induced spinal cord injury (CIS) occurring after cerebral angiography with a nonionic contrast agent, Ioversol. The patient initially experienced contrast-induced encephalopathy (CIE) before developing CIS. The patient's symptoms improved with treatment and rehabilitation, but the case highlights the importance of considering CIS as a potential complication of cerebral angiography, even with the use of nonionic contrast agents. The authors reviewed existing literature and suggest potential risk factors for CIS include cervical spondylosis with canal stenosis and accidental injection into the left thyrocervical trunk.

Practical Implications

Increased Awareness

Healthcare professionals should be aware of the possibility of CIS even when using nonionic contrast agents.

Risk Factor Assessment

Patients undergoing cerebral angiography should be assessed for risk factors such as cervical spondylosis and anatomical variations in blood vessel supply.

Cautious Injection Technique

Careful catheter placement and injection technique are essential to avoid unintended injection into the thyrocervical trunk.

Study Limitations

  • 1
    Single case report limits generalizability.
  • 2
    Pathogenesis mechanisms are not fully understood.
  • 3
    Limited number of CIS cases reported in the literature.

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