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Table of Contents    
Year : 2022  |  Volume : 70  |  Issue : 4  |  Page : 1678-1679

Recurrent Iodixanol-induced Transitory Mental Disorder in a Woman After Percutaneous Coronary Intervention

Department of Cardiology, the Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China

Date of Submission02-Nov-2020
Date of Decision13-Jul-2022
Date of Acceptance31-Jul-2022
Date of Web Publication30-Aug-2022

Correspondence Address:
Lin Zhong
Department of Cardiology, No. 20 East Yuhuangding Road, Yantai 264000
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.355090

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How to cite this article:
Wang H, Zhong L. Recurrent Iodixanol-induced Transitory Mental Disorder in a Woman After Percutaneous Coronary Intervention. Neurol India 2022;70:1678-9

How to cite this URL:
Wang H, Zhong L. Recurrent Iodixanol-induced Transitory Mental Disorder in a Woman After Percutaneous Coronary Intervention. Neurol India [serial online] 2022 [cited 2023 Dec 7];70:1678-9. Available from:


A 66-year-old woman presented with chest pain with two stents implanted in the circumflex branch in 2015. She had a history of hypertension. Her blood pressure was 182/89 mmHg on admission. Three years prior, 1 h after the percutaneous coronary intervention (PCI), during which 100 mL of iodinated contrast agent was used, she became drowsy but woke to painful stimuli. The patient recovered spontaneously after 10 h without any neurological deficits. This time, following the pretreatment with intravenous 500 mL saline solution because of a previous reaction to iodine contrast, coronary angiography revealed chronic total occlusion (CTO) of the right coronary artery (RCA) [Figure 1]a. Successful PCI was performed in 40 min. Two drug-eluting stents were implanted and the occluded artery was reperfused [Figure 1]b. The total amount of iodixanol used in the cardiac catheterization was 150 mL. Uncontrolled hypertension occurred during the procedure, although the nitroglycerin was pumped continuously. The blood pressure fluctuates in a range of 180–200/100–110 mmHg. One hour after the procedure, she developed a mental disorder. However, she had normal strength and coordination in all limbs. Computed tomography (CT) scanning of the brain performed within 30 min of symptom onset demonstrated no abnormality [Figure 2]a, [Figure 2]b, [Figure 2]c. The blood gas analysis, glucose, ammonia, and electrolyte were normal. She was treated with supportive therapy consisting of adequate hydration, glucocorticoid, and close monitoring. She regained clear mentation within 36 h and she could not recollect the event immediately following angiography. CT imaging repeated on the next day showed no abnormalities compared with the initial CT scan [Figure 2]d, [Figure 2]e, [Figure 2]f.
Figure 1: Coronary angiography imaging of the patient. (a) Coronary angiogram showing chronic total occlusion (CTO) of the right coronary artery (arrows). (b) Coronary angiogram showing no stenosis of the right coronary artery following stent implantation (arrows)

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Figure 2: Cerebral computed tomography of the patients. (a-c) A computed tomography of the brain shortly after the onset of the symptom showed slight edema, a little loss of the cerebral sulci, and no subarachnoid hemorrhage or cerebral ischemia. (d-f) A computed tomography of the brain on the next day revealed no abnormality

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The woman was diagnosed with contrast-induced encephalopathy (CIE), which is described as acute, transient, and nonspecific dysfunction of the central nervous system if it occurs within a narrow time interval after intravascular administration of contrast medium. Osmotic disruption of the blood-brain barrier and direct neuronal toxicity of contrast medium are involved in the pathophysiology. The rarity of CIE makes it a diagnostic challenge that entails the exclusion of subarachnoid hemorrhage and stroke. A multifactorial approach is used widely for CIE prevention including prophylactic intravenous hydration before and after contrast administration, administration of low- or iso-osmolar contrast medium, and controlling of the blood pressure. We believed that the history of contrast agent exposure and uncontrolled hypertension were the main risk factors. We emphasize the need for further awareness of CIE, identifying patients at high risk, so as to make the correct diagnosis and take effective prevention.


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Financial support and sponsorship

This work was supported by the research grants from the Science and Technology planning project of Yantai City (2021MSG044).

Conflicts of interest

There are no conflicts of interest.


  [Figure 1], [Figure 2]


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