Key result
Ioversol during vein of Marshall ethanol infusion causes contrast-induced encephalopathy resolving within ~48 hours.
Why the study?
Contrast-induced encephalopathy is a rare, reversible neurologic complication of iodinated contrast exposure that can mimic acute stroke.
Case Report (n=1)
No
Contrast-induced encephalopathy is a rare, reversible stroke mimic that can occur after iodinated contrast exposure during vein of Marshall ethanol infusion and resolves with supportive care.
CIE should remain in the differential for post-procedural neurologic deficits; this case leaves open questions on incidence and risk factors with vein of Marshall ethanol infusion.
BACKGROUND: Contrast-induced encephalopathy (CIE) is a rare, reversible neurologic complication of iodinated contrast exposure that may mimic acute stroke. CASE SUMMARY: A 68-year-old man undergoing atrial fibrillation ablation with vein of Marshall ethanol infusion received 40 mL of ioversol. Approximately 4 hours after the procedure, he developed agitation, myoclonic movements, urinary incontinence, and left-sided weakness. Brain computed tomography, magnetic resonance imaging, magnetic resonance angiography, and diffusion-weighted imaging showed no hemorrhage, acute infarction, or major vascular abnormality. Similar neurologic symptoms recurred approximately 10 hours after the procedure. After neurologic consultation, CIE was considered the most likely diagnosis. Supportive treatment was provided, with complete neurologic recovery within 48 hours. DISCUSSION: CIE should be considered when acute neurologic manifestations occur after contrast exposure, particularly when initial evaluation does not demonstrate an acute cerebrovascular cause. TAKE-HOME MESSAGE: Recognition of CIE as a stroke mimic may facilitate appropriate evaluation and management while avoiding unnecessary intervention.
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Nie et al. (2026) conducted a case report in Contrast-induced encephalopathy mimicking stroke during atrial fibrillation ablation (n=1). Ioversol contrast exposure during vein of Marshall ethanol infusion was evaluated on Complete neurologic recovery from contrast-induced encephalopathy. Ioversol (40 mL) during vein of Marshall ethanol infusion caused contrast-induced encephalopathy at 4 and 10 hours, resolving within 48 hours with supportive care.
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