Confirmation of a Diagnosis by CSF Analysis in a Case of Symptomatic Contrast-induced Encephalopathy with an Onset Immediately after Coil Embolization of an Unruptured Cerebral Aneurysm

Abstract

Objective: A case of contrast-induced encephalopathy, a complication of intracranial endovascular treatment, in which the measurement of the iodine concentration in cerebrospinal fluid (CSF) was effective for the diagnosis is reported.

Case Presentations: An 85-year-old woman underwent coil embolization of an unruptured aneurysm at the left internal carotid artery-posterior communicating artery bifurcation. Since recurrence was noted after one year, additional coil embolization was performed. After the procedure, she presented with right hemiplegia and aphasia, and head CT scans immediately after the procedure showed high-density areas in the cortex and sulci of the left cerebral hemisphere. On the day after the procedure, the high-density areas disappeared, and the symptoms were resolved by conservative treatment. Since CSF analysis after the procedure demonstrated marked elevation of the iodine concentration, a diagnosis of contrast-induced encephalopathy was made on the basis of this finding along with the CT findings and symptomatic course.

Conclusion: Measurement of the iodine concentration in CSF immediately after endovascular treatment is useful for the diagnosis of contrast-induced encephalopathy.