Contrast-induced encephalopathy with visual and auditory hallucinations triggered by coronary angiography with iodixanol: a case report.

Background: Contrast-induced encephalopathy (CIE) is a rare complication of coronary angiography posing a significant diagnostic challenge. Its incidence has substantially declined with the introduction of nonionic low-osmolar contrast media and, in most cases, it manifests with transient cortical blindness. Concomitant visual and auditory hallucinations in the course of CIE have never been reported.

Case report: We present the first reported case of CIE with concomitant visual and auditory hallucinations following coronary angiography in an 80-year-old female patient. The procedure was elective and performed via right radial approach. During the procedure, significant difficulties in crossing a tortuous and calcified brachiocephalic trunk were encountered. The patient lost awareness of time and place, became agitated and started having aphasia. Periprocedural stroke was suspected as a consequence of atherosclerotic plaque mobilization and dislodging atheromatous material to the cerebral vasculature. The patient became fully oriented without aphasia within 24 h, but started having auditory and visual hallucinations. Stroke was excluded by an urgent MRI, and ultimately CIE was diagnosed. A supportive therapy with sedation and intravenous hydration was used with subsequent commencement of quetiapine treatment for hallucinations. The symptoms resolved after 5 days, and quetiapine was successfully discontinued.

Conclusions: Based on the unique case report, CIE may manifest with concomitant visual and auditory hallucinations. In some instances, the clinical entity may mimic stroke; therefore, it is crucial to rule out this acute neurological condition and prevent patients from receiving a potentially harmful treatment.