Complications During Neuro Diagnostic Study Cause Significant Brain Damage

This case involves a patient who presented to the hospital with complaints of dizziness, numbness to the fingertips and face, and shortness of breath. A CT without contrast revealed a large non-specific oval-shaped mass centered in the region of the left petrous bone with associated bone erosion. Radiological reports stated that the lesion was suspicious for chondrosarcoma. A further CT angiography demonstrated a non-enhancing hyperdense extra-axial mass with the left middle cranial fossa. During the procedure, venography was performed in an attempt to diagnose the venous drainage of the lesion but this step was met with some difficulty in passing the dye contrast. The pressure of the dye injection device was increased to facilitate adequate flow. The images show severe extravasation of dye contrast into the surrounding brain parenchyma and the physical exam of the patient showed blown pupils.

Question(s) For Expert Witness

1. Is this a known complication of the procedure?

Expert Witness Response E-000572

Major complications in cerebral angiography are rare but include stroke, an allergic reaction to the anaesthetic other medication or the contrast medium, blockage or damage to one of the access veins in the leg, or thrombosis and embolism formation. Bleeding or bruising at the site where the contrast is injected are minor complications, delayed bleeding can also occur but is rare. I would say that this case is very difficult since the patient had an ongoing issue with possible brain malignancy and the introduction of extra fluid into the cranial may have contributed to a mass effect and subsequent brain herniation which caused the adverse outcome.