PMC7723034_01
Contrast-induced encephalopathy in brain computed tomography (CT) scans. (A) Emergency brain CT showed no acute pathological findings. (B) Brain CT 2 hours after surgery indicated multiple high-density regions in the subarachnoid space. (C) Brain CT 10 hours after surgery showed significantly swollen brain tissue, particularly in the right hemisphere, the left frontal lobe, and the left occipital lobe. The high-density shading in the subarachnoid cavity was significantly denser than in previous scans. (D) Brain CT 72 hours after surgery showed the sulci of the right hemisphere became shallow, and low-density shadows could be seen in the frontal parietal lobe. But cerebral edema was significantly improved.
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Emergency computed tomography (CT) was performed, which showed no acute pathological findings (Figure 1A). Cerebral angiography showed no stenosis, thrombosis, or hemorrhage in the bilateral carotid artery, the middle cerebral artery, or the anterior cerebral artery, which indicated absence of any cerebrovascular events (Supplementary Figure S1). Brain CT examination 2 hours after surgery showed multiple high-density regions in the subarachnoid space (Figure 1B), which indicated potential subarachnoid hemorrhage or contrast agent leakage. Brain CT examination 10 hours after surgery showed significantly swollen brain tissue, particularly in the right hemisphere, the left frontal lobe, and the left occipital lobe, with more obvious swelling in the right hemisphere (Figure 1C). However, cerebral edema was significantly improved compared with that observed 3 days prior (Figure 1D).
Computed tomography angiography (CTA) showed no evidence of macrovascular embolism in (A) posteroanterior (PA), (B) posterior (P) and (C) left anterior oblique (LAO) view.
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Brain magnetic resonance imaging (MRI) 2 hours after surgery showed hyperintense areas in the right cortex in (A) T2-weighted image and (B) fluid-attenuated inversion recovery (FLAIR) images, and no clear signs of subarachnoid hemorrhage were observed on (C) diffusion-weighted imaging (DWI).
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T2-weighted image and fluid-attenuated inversion recovery (FLAIR) in frontal, parietal, temporal and occipital of right cortex, and no clear signs of subarachnoid hemorrhage were observed in diffusion-weighted imaging (DWI) (Figure 3). The patient was given fluids to accelerate excretion of contrast agent, sodium valproate 60 mg per hour to treat epilepsy, mannitol 125 mL every 6 hours to dehydrate and reduce intracranial pressure, nimodipine 10 mg once a day to prevent vasospasm, and other drugs to improve clinical symptoms.