iothalamate-meglumine and Blindness

Numerous experimental studies have demonstrated disruption of the blood-brain barrier by the hyperosmolar, iodinated contrast agents in common use for intravascular injection during radiologic studies. We report 4 cases in which cortical blindness occurred after cerebral angiography. The patients underwent x-ray CT within 1 hour. CT showed abnormal contrast enhancement in the occipital regions in all 4 instances. Two patients underwent MRI; 1 of these manifested abnormal high-signal intensity in the occipital lobes on T2-weighted images. Only 2 previous cases documenting immediate contrast enhancement within the brain substance on CT following angiography are in the literature.

Topics: Aged; Blindness; Blood-Brain Barrier; Brain; Brain Stem; Diatrizoate Meglumine; Female; Humans; Iothalamate Meglumine; Magnetic Resonance Imaging; Male; Middle Aged; Tomography, X-Ray Computed

Whereas most ocular complications following cerebral angiography are benign and transient, central retinal artery occlusion following cerebral angiography produces severe permanent visual deficits in nearly 40% of patients. Physicians ordering and performing cerebral angiography should be aware of this complication, since immediate attention to patients with visual disturbance from central retinal artery occlusion may save useful vision. All previously reported cases of central retinal artery occlusion following cerebral angiography have occurred after direct percutaneous carotid angiography. We report a case of central retinal artery occlusion following transfemoral cerebral angiography using a #5 French catheter and meglumine iothalamate (Conray-60) contrast.

Topics: Arterial Occlusive Diseases; Blindness; Carotid Artery, Internal; Cerebral Angiography; Endarterectomy; Fundus Oculi; Humans; Iothalamate Meglumine; Male; Middle Aged; Retinal Artery; Vision, Ocular