Contrast-Induced Encephalopathy after Endovascular Treatment: Three Case Reports

Background Contrast-induced encephalopathy (CIE) is a rare yet potentially severe complication that occurs during or after angiography, typically presenting as a transient and self-limiting condition. It often presents with stroke-like symptoms, which can easily lead to clinical misdiagnosis. Herein, we report three cases of CIE in patients who underwent repeated digital subtraction angiography (DSA). Case presentation: Case 1 was a 68-year-old female admitted to the hospital for angiography after aneurysm surgery. However, after the second cerebral angiography, the patient developed left limb weakness. Emergency computed tomography angiography (CTA) showed no abnormalities, and CIE was suspected. Her neurological deficits completely resolved within 24 h of corticosteroid treatment and rehydration. Case 2 was a 50-year-old man with an intracranial aneurysm. After the second aneurysm embolization procedure by DSA, he developed vomit, headaches, skin erythema, slurred speech, and limb weakness. The cerebral computed tomography (CT) scan revealed edema in the interhemispheric fissure, the left sylvian fissure, and parts of the cerebral sulci. On postoperative day 3, his neurologic deficits and allergic reaction completely resolved after treatment with symptomatic supportive therapy. Case 3 was a 70-year-old female admitted for re-embolization of a residual aneurysm sac after multiple DSA procedures. At this time, she developed aphasia, confusion, and right hemiplegia one-hour post-procedure. Magnetic resonance imaging (MRI) revealed left frontal gyral edema. After treatment with corticosteroids, mannitol, and hydration, the patient’s neurological function improved significantly. Conclusions These three cases highlight a potential association between recurrent DSA exposure and the risk of CIE. Clinicians should maintain a high index of suspicion for CIE when evaluating patients with acute neurological impairments after angiography, especially those who have undergone repeated DSA procedures.