Acute encephalopathy associated with anaphylactic shock caused by angiographic radiocontrast media: An unusual case

Year 2022, Volume: 39 Issue: 2, 574 - 576, 18.03.2022

Emre Özdemir , Ayşen Süzen , Mustafa Karaca

Abstract

Radiocontrast medias have been used with increasing frequency for centuries. Radiocontrast medias may have the spectrum up to anaphylaxis as a side effect. The case is here presented of a patient with acute encephalopathy, associated with the anaphylactic shock of angiographic radiocontrast media. A 67-year old male patient with a diagnosis of abdominal aortic aneurysm(AAA) was referred for coronary and peripheral angiographic evaluation before the AAA operation. After the angiographic examination was completed, the patient developed complaints of dyspnea, stridor, flushing and eruption. The patient recovered totally after a successful medical intervention was performed to anaphylaxis. Decorticated posture gradually developed and the patient lost consciousness again. The patient recovered completely after a seizure with antiepileptic treatment without any diagnostic imaging. Nonconvulsive status epilepticus must be considered after the allergic reaction and anti-epileptic agents should be taken into consideration in addition to preventing hypoxia and hypoperfusion.

Keywords

Radiocontrast media, anaphylaxis, hypoxia, nonconvulsive status epilepticus

Project Number

yok

References

• 1. Wu YW, Leow KS, Zhu Y, Tan CH. Prevention and management of adverse reactions induced by iodinated contrast media. Ann Acad Med Singapore 2016: 45; 157-164.
• 2. Soufras GD, Kounis NG . Brain injury due to anaphylactic shock: broadening manifestations of Kounis syndrome. Int Endod J. 2014: 47(4): 309-313
• 3. Ding YJ, Song H, Liu JH, Wang G H. Brain injury due to anaphylactic shock as a result of formocresol used during root canal treatment. Int Endod J. 2013: 46(10): 999-1005.
• 4. Kounis NG Kounis syndrome (allergic angina and allergic myocardial infarction): a natural paradigm? Int J Cardiol. 2006: 110; 7–14
• 5. González-de-Olano D, Alvarez-Twose I, Matito A, Sanchez-Munoz L, Kounis NG, Escribano L. Mast cell activation disorders presenting with cerebral vasospasm-related symptoms: a “Kounis-like” syndrome?. Int J Cardiol. 2011: 150(2); 210-211.
• 6. Goto M, Matsuzaki M, Fuchinoue A, Urabe N, Kawagoe N, Takemoto I, et al. Chronic atherosclerotic mesenteric ischemia that started to develop symptoms just after anaphylaxis. Case Rep Gastroenterol 2012:6, 300–308.
• 7. Peláez-Pérez JM, Casado MS, Álvarez-Twose I, Kounis NG. Amoxicillin–clavulanic acid-induced type II Kounis syndrome during general anaesthesia complicated with hypoxic–ischaemic encephalopathy. Rev Esp Anestesiol Reanim. Available online 7 August 2019, Acessed 9 Jan 2021. https://doi.org/10.1016/j.redar.2019.06.002
• 8. Speach DP, Wong TM, Cattarin JA, Livecchi MA Hypoxic brain injury with motor apraxia following an anaphylactic reaction to hymenoptera venom. Brain Injury. 1998; 12, 239–244.
• 9. Schäbitz WR, Berger C, Knauth M, Meinck HM, Steiner T. Hypoxic brain damage after intramuscular self-injection of diclofenac for acute back pain. Eur J Anaesthesiol. 2001: 18(11); 763-765.
• 10. Arishima H, Hosoda T, Hashimoto N et al. Hypoxic ischemic encephalopathy with atypical findings on CT and MR imaging: two case reports. Brain and Nerve 2009: 61; 874–879.