Subdural contrast extravasation after percutaneous coronary intervention mimicking acute subdural hematoma A case report

Rationale: Subdural contrast extravasation (SCE) is a rare and possible complication following the intravascular injection of a contrast agent. We report a case of interhemispheric SCE detected by computed tomography (CT) after percutaneous coronary intervention. Patient concerns: A 71-year-old man suddenly lost consciousness and fainted 2 hours prior with a head trauma history. Percutaneous coronary intervention was performed on the second day. Diagnoses: Head CT findings showed that the anterior longitudinal fissure of the brain was banded with high density and was uneven in thickness. The edge of the falx side of the brain was straight, smooth, and sharp, and the edge of the brain parenchyma was clear, without obvious edema or a space-occupying effect. Interventions: Ticagrelor was given as an antiplatelet therapy; analgesic, antispasmodic symptomatic and supportive treatment was also administered. Outcomes: Two days later, the band-like high density between cerebral hemispheres was completely absorbed, and the patient's condition improved and his headache resolved. Lessons: SCE is relatively uncommon during or after the intravascular injection of contrast media. Familiarity with the clinical features and CT findings of SCE may increase clinicians' awareness of this disease, thus avoiding potential misdiagnosis and mistreatment.

Automated summary

Subdural contrast extravasation is a rare complication following the intravascular injection of a contrast agent. In this case, a 71-year-old male patient with interhemispheric SCE after percutaneous coronary intervention showed improvement after receiving supportive treatment. Familiarity with the clinical features and CT findings of SCE can help increase awareness among clinicians, potentially avoiding misdiagnosis and mistreatment.