Korean Circ J.  2012 Mar;42(3):197-200. 10.4070/kcj.2012.42.3.197.

Subarachnoid Hemorrhage Mimicking Leakage of Contrast Media After Coronary Angiography

• Oh MS
• Kwon JE
• Kim KJ
• Jo JH
• Min YJ
• Byun JS
• Kim KT
• Kim SW
• Kim TH

• KMID: 2225034
• DOI: http://doi.org/10.4070/kcj.2012.42.3.197

Abstract

We report a patient who developed subarachnoid hemorrhage (SAH) just after coronary angiography (CAG) with non-ionic contrast media (CM) and minimal dose of heparin. The 55-year-old man had a history of acute ST elevation myocardial infarction that had been treated with primary percutaneous coronary intervention and was admitted for a follow-up CAG. The CAG was performed by the transradial approach, using 1000 U of unfractionated heparin for the luminal coating and 70 mL of iodixanol. At the end of CAG, he complained of nausea and rapidly became stuporous. Brain CT showed a diffusely increased Hounsfield unit (HU) in the cisternal space, similar to leakage of CM. The maximal HU was 65 in the cisternal space. No vascular malformations were detected on cerebral angiography. The patient partially recovered his mental status and motor weakness after 2 days. Two weeks later, subacute SAH was evident on magnetic resonance imaging. The patient was discharged after 28 days.

Keyword

Subarachnoid hemorrhage; Iodixanol; Coronary angiography

MeSH Terms

Brain
Cerebral Angiography
Contrast Media
Coronary Angiography
Follow-Up Studies
Heparin
Humans
Magnetic Resonance Imaging
Middle Aged
Myocardial Infarction
Nausea
Percutaneous Coronary Intervention
Phenobarbital
Stupor
Subarachnoid Hemorrhage
Triiodobenzoic Acids
Vascular Malformations
Contrast Media
Heparin
Phenobarbital
Triiodobenzoic Acids

Figure

• 

  Fig. 1 Angiographic findings of the right coronary artery. A: totally occluded right coronary artery at the initial coronary angiography for primary percutaneous coronary intervention. B: patent previous TAXUS Liberté stent on follow-up coronary angiography performed 15 months later.

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  Fig. 2 Initial brain CT shows. A: diffuse acute subarachnoid hemorrhage (maximum 65 HU) in the basal, interpeduncular, ambient and both lateral cisterns. B and C: CT scan shows almost complete resolution of the acute SAH after 2 days. SAH: subarachnoid hemorrhage.

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  Fig. 3 Two weeks after the SAH, magnetic resonance (MR) image shows hyperdense material in the supravermian cistern on both T1 (A) and T2 (B) weighted images (arrows), suggesting remnant subacute SAH. The MR angiogram reveals no evidence of aneurysm in the major intracranial vessels (C). SAH: subarachnoid hemorrhage.

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