A case report of contrast-induced encephalopathy mimicking percheron infarction

Contrast-induced encephalopathy (CIE) is a recognized complication associated with the use of iodinated contrast media in angiography and vascular interventions. Typically, CIE presents on computed tomography (CT) with localized cortical enhancement, increased density in the subarachnoid space, and cerebral edema. Lesions are usually located in the deep perforating branch areas and are relatively rare. We present the case of a 61-year-old male who underwent interventional treatment for an arteriovenous fistula and was subsequently diagnosed with CIE. Twenty minutes post-procedure, the patient exhibited drowsiness, and a brain CT scan revealed symmetrical high-density lesions in the bilateral thalami. Following two days of conservative management, the patient experienced spontaneous resolution of the CT lesions without any neurological deficits. This case underscores the importance of immediate postoperative cranial imaging to exclude potential complications from angiography. Additionally, it is extremely rare for CIE to present with bilateral thalamic lesions.