Neurological Complications Following Cerebral Angiography: A Case of Contrast- Induced Encephalopathy

Background: Contrast-induced encephalopathy (CIE) is a rare but increasingly recognized iatrogenic complication associated with intravascular iodinated contrast use, particularly during neurovascular procedures. It often presents acute neurological deficits that mimic ischemic stroke or seizure disorders. Despite its often-reversible course, radiological and electroclinical mimicry of other acute conditions poses a diagnostic dilemma. Case Presentation: We report an 82-year-old woman with multiple vascular comorbidities who developed acute left hemiparesis and conjugate gaze deviation following diagnostic cerebral angiography. Initial non-contrast CT revealed a dense right middle cerebral artery (MCA) sign, raising concerns about acute large vessel occlusion. However, later angiography revealed no such occlusion. Supportive neurocritical care, including hydration and anticonvulsant therapy, resulted in complete neurological recovery within five days. The EEG showed focal cortical dysfunction without epileptiform activity. Interval imaging confirmed the resolution of right hemispheric edema. Conclusion: This case underscores the diagnostic challenges of CIE, particularly its ability to radiologically and clinically simulate acute ischemic stroke. The absence of EEG epileptiform discharges despite convulsive symptoms highlights the non-epileptic mechanisms of contrast-induced neurotoxicity. Enhanced interdisciplinary awareness and radiologic vigilance are essential to prevent unnecessary interventions and to improve outcomes.