Spinal Myoclonus Post-CRT-D Implantation: A Rare Case Report of Iodinated Contrast Neurotoxicity

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ID: 316906
2026
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Abstract
Abstract Background Contrast-induced neurotoxicity (CIN) is a rare complication of iodinated contrast agents, with spinal myoclonus representing an exceptionally uncommon manifestation (<0.01%). To date, no cases have been reported following cardiac resynchronization therapy with defibrillator (CRT-D) implantation. Case Summary A 65-year-old man with advanced heart failure (LVEF 28%, NYHA III, QRS 162 ms) underwent successful CRT-D implantation using 50 mL of iopamidol. Four hours post-procedure, he developed sudden, generalized, stimulus-sensitive spinal myoclonus with preserved consciousness. Electroencephalography was normal. Brain and cervical-thoracic spinal MRI on day 3 showed no ischemic, hemorrhagic, or inflammatory lesions. Serum creatinine remained stable. Intravenous hydration and clonazepam resulted in complete resolution within 72 hours, with no neurological sequelae at three-month follow-up (NYHA II, LVEF 38%). Discussion This represents the first documented case of iodinated contrast-induced spinal myoclonus following CRT-D implantation, occurring with the lowest reported contrast volume (50 mL) and preserved renal function. Normal neuroimaging and rapid reversibility under supportive therapy confirm a functional, non-structural mechanism. This case expands the spectrum of CIN in device-based heart failure therapy and emphasizes the need for heightened clinical awareness during coronary sinus cannulation, even in low-risk patients. Early recognition and simple supportive measures ensure excellent outcomes.
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Authors Jaouad NGUADI, Mohamed ennmer, Jihane Fagouri, Hicham Bouzelmat, Ali Chaib
Journal European Heart Journal - Case Reports
Year 2026
DOI
10.1093/ehjcr/ytag416
URL
https://doi.org/10.1093/ehjcr/ytag416
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