Not a Stroke: Reversible Contrast-Induced Encephalopathy Presenting with Acute Aphasia

Contrast-induced encephalopathy (CIE) is a rare but dramatic complication of coronary angiography that can mimic acute ischemic stroke.Differentiating CIE from cerebrovascular accidents is critical to avoid inappropriate thrombolytic therapy and potential catastrophic hemorrhage.We present a case of a 69-year-old male with a history of hypertension and diabetes who underwent elective coronary angiography.Following the administration of Iohexol (Omnipaque™), the patient developed acute onset fluent aphasia (Wernicke-type) and confusion immediately after the procedure.Urgent cranial Computed Tomography (CT) ruled out hemorrhage but revealed no acute infarction.Diffusion-Weighted Magnetic Resonance Imaging (DWI-MRI) demonstrated a focal hyperintensity restricted to the splenium of the corpus callosum (SCC), a finding consistent with cytotoxic lesions of the corpus callosum (CLOCCs).In conclusion, CIE should be considered in the differential diagnosis of patients presenting with new-onset neurological deficits immediately after contrast administration, even with modern non-ionic agents.The recognition of reversible splenial lesions on MRI is a key diagnostic feature that allows for the avoidance of unnecessary thrombolysis and ensures appropriate conservative management.