Transient Visuospatial Disorder From Angiographic Contrast
Michael P. Merchut, MD;
Bunnie Richie, DO
Arch Neurol. 2002;59:851-854.
Background The blood-brain barrier may be permeable under the clinical settings
of uncontrolled hypertension, renal insufficiency, immunosuppressive drugs,
and intravascular radiographic contrast. Some reversible neurological complications
after angiography are caused by cortical penetration of contrast media detected
on brain computed tomographic (CT) scans.
Objectives To describe the first report of a transient visuospatial disorder having
elements of Balint syndrome, and caused by angiographic contrast penetration
of the bilateral parieto-occipital cortex; and to review cases published between
1980 and 2001 of cortical contrast penetration, documented by CT.
Results Simultanagnosia, optic ataxia, and ocular apraxia occurred in a 74-year-old
woman who received nonionic contrast media during a failed renal angioplasty.
Contrast noted in the bilateral parieto-occipital cortex on the initial CT
scan disappeared after 4 days with clinical resolution.
Conclusions Angiographic contrast tends to breach the blood-brain barrier of the
vertebrobasilar circulation, penetrating the occipital cortex and leading
to transient, localizable syndromes of cortical blindness or abnormal visuospatial
processing.
From the Department of Neurology, Loyola University Medical Center,
Maywood, Ill.
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