A man in his 60s was found to have a 7 mm incidental anterior communicating artery aneurysm on CT while being investigated for debilitating migraines, and subsequently underwent catheter cerebral angiography for endovascular treatment planning. Approximately 1 hour post angiogram, the patient reported reduced vision and a headache. His symptoms rapidly progressed to a severe headache, increased agitation, confusion, cortical blindness and combative behaviour. CT and MRI revealed no acute intracranial abnormality, and he was transferred to the intensive care unit for supportive care. His condition gradually improved, and he was discharged 4 days later with no focal neurological deficit. Contrast-induced neurotoxicity (CIN) was diagnosed as a diagnosis of exclusion. This case highlights the importance of recognising and managing CIN and shows that CT/MRI findings in the immediate setting of CIN may be normal. Thus, clinical recognition, early intervention and interdisciplinary collaboration are crucial for ensuring favourable outcomes.
Dabbagh et al. (2026) studied this question.