Serious Blood-Brain Barrier Disruption after Coil Embolization of Unruptured Intracranial Aneurysm : Report of Two Cases and Role of Immediate Postembolization CT Scan.

Abnormal contrast enhancement on brain computed tomography (CT) scan after diagnostic or interventional angiography is not rare, and has known to be induced by temporary blood-brain barrier (BBB) disruption from contrast media. Furthermore, it has been regarded as clinically subtle, but reported to have no symptom or mild transient symptoms. However, we recently experienced two cases of serious BBB disruption during the acute period after coiling of an unruptured intracranial aneurysm. One patient presented with an unruptured paraclinoid internal carotid artery (ICA) aneurysm on the right and the other with an unruptured right supraclinoid ICA aneurysm. Both patients showed similar findings on immediate postembolization CT scan and clinical courses after coiling. Typical radiological, clinical characteristics of BBB disruption were described. In addition, the role of immediate postembolization CT scan are also discussed.

[1]  J. Brisman,et al.  Contrast Enhancement Hyperdensity After Endovascular Coiling of Intracranial Aneurysms , 2008, American Journal of Neuroradiology.

[2]  S. Baik,et al.  Immediate CT findings following embolization of cerebral aneurysms: suggestion of blood–brain barrier or vascular permeability change , 2008, Neuroradiology.

[3]  M. Hirohata,et al.  Factors contributing to blood–brain barrier disruption following intracarotid injection of nonionic iodinated contrast medium for cerebral angiography: experimental study in rabbits , 2006, Radiation Medicine.

[4]  M. Hirohata,et al.  Blood brain-barrier disruption of nonionic iodinated contrast medium following coil embolization of a ruptured intracerebral aneurysm. , 2004, AJNR. American journal of neuroradiology.

[5]  Hans-Joachim Mentzel,et al.  Cortical blindness after contrast-enhanced CT: complication in a patient with diabetes insipidus. , 2003, AJNR. American journal of neuroradiology.

[6]  G. Hamann,et al.  Nonionic Contrast Neurotoxicity after Coronary Angiography Mimicking Subarachnoid Hemorrhage , 2003, European Neurology.

[7]  Sven-Göran Fransson,et al.  Nephrotoxic effects in high-risk patients undergoing angiography. , 2003, The New England journal of medicine.

[8]  Geoffrey S. F. Ling,et al.  Contrast agent overdose causing brain retention of contrast, seizures, and parkinsonism , 1993, Neurology.

[9]  A. Wilson,et al.  Effects of nonionic contrast media on the blood-brain barrier. Osmolality versus chemotoxicity. , 1991, Investigative radiology.

[10]  S. Takebayashi,et al.  Disruption of the blood-brain barrier caused by nonionic contrast medium used for abdominal angiography: CT demonstration. , 1989, Journal of computer assisted tomography.