Stato emiconvulsivo dopo somministrazione intra-arteriosa di contrasto

It is a common opinion that extravasation of contrast medium in ischemic areas may damage brain tissue. Nevertheless, after the advent of intra-arterial thrombolysis, angiography is often performed early in ischemic stroke. We report a 75-year old woman who developed a left hemi-convulsive status following angiography performed for a transient ischemic event which occurred after right carotid endoarteriectomy. In this patient, the association of reperfusion with intra-arterial contrast bolus induced a status epilepticus. EEG pattern was peculiar with right epileptic discharges followed by a sustained and diffuse suppression of electric activity. Epileptic status recovered only after Propofol treatment. TPM (200 mg daily) was necessary to maintain the patient seizure-free.