Анестезия и клинические исследования
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ISSN: 2155-6148
ISSN: 2155-6148
Emília Francisco, Francisco Seixas, Angela Carmezim Mota, Manuela Pereira and Humberto S Machado
Background and objectives: Contrast-induced encephalopathy (CIE) after endovascular lower limb revascularization is an uncommon complication caused by the administration of intravascular contrast media. The clinical presentation of CIE is variable, ranging from cortical blindness to encephalopathy, seizures, and focal neurological deficits. It is often an exclusion diagnosis. In this case, CIE remains the most likely diagnosis on the basis of the symptoms and typical radiological findings. The authors want to point up how blindness after surgery led to CIE diagnosis and all the major complications that followed with patient dead.
Case report: We describe a case of a 77 year-old male patient who developed CIE after endovascular lower limb revascularization of the right iliac artery. He had a history of high blood pressure, type II diabetes mellitus, peripheral artery disease and cerebrovascular disease. Surgical procedure under general anesthesia was uneventful. The patient started complaining of bilateral blindness short after arrival at the Post Anesthesia Care Unit (PACU). A vascular event was excluded and the diagnosis of CIE was suggested through a cerebral angiography computed tomography scan. On the return to the PACU the patient developed hypovolemic shock from retroperitoneal hemorrhage. The event proved fatal despite further surgery and all resuscitative efforts.
Conclusion: This case highlights and should raise clinical awareness of a rare but important complication follow endovascular lower limb revascularization. CIE presented as blindness, a very rare complain after surgery. The diagnosis is challenging and requires imaging confirmation. Mobilization of the patient carries risks. In this case the retroperitoneal hemorrhage that followed proved fatal to the patient.