{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T13:00:50Z","timestamp":1781614850258,"version":"3.54.5"},"reference-count":6,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Contrast-induced neurotoxicity (CIN) is a rare complication of iodinated contrast agents, with spinal myoclonus representing an exceptionally uncommon manifestation (&amp;lt;0.01%). To date, no cases have been reported following cardiac resynchronization therapy with defibrillator (CRT-D) implantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 65-year-old man with advanced heart failure (LVEF 28%, NYHA III, QRS 162\u2005ms) underwent successful CRT-D implantation using 50\u2005mL 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 ischaemic, haemorrhagic, or inflammatory lesions. Serum creatinine remained stable. Intravenous hydration and clonazepam resulted in complete resolution within 72\u2005h, with no neurological sequelae at three-month follow-up (NYHA II, LVEF 38%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This represents the first documented case of iodinated contrast-induced spinal myoclonus following CRT-D implantation, occurring with the lowest reported contrast volume (50\u2005mL) 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag416","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T11:31:54Z","timestamp":1781004714000},"source":"Crossref","is-referenced-by-count":0,"title":["Spinal myoclonus post-CRT-D implantation: a rare case report of iodinated contrast neurotoxicity"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2318-7248","authenticated-orcid":false,"given":"Jaouad","family":"Nguadi","sequence":"first","affiliation":[{"name":"Department of Cardiology, Mohammed V Military Training Hospital , Rabat 10000 ,","place":["Morocco"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Ennmer","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mohammed V Military Training Hospital , Rabat 10000 ,","place":["Morocco"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihane","family":"Fagouri","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mohammed V Military Training Hospital , Rabat 10000 ,","place":["Morocco"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hicham","family":"Bouzelmat","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mohammed V Military Training Hospital , Rabat 10000 ,","place":["Morocco"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Chaib","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Mohammed V Military Training Hospital , Rabat 10000 ,","place":["Morocco"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,10]]},"reference":[{"key":"2026061608414672800_ytag416-B1","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"2026061608414672800_ytag416-B2","first-page":"267860","article-title":"Contrast-induced neurotoxicity following cardiac catheterization","volume":"2012","author":"Law","year":"2012","journal-title":"Case Rep Neurol Med"},{"key":"2026061608414672800_ytag416-B3","doi-asserted-by":"crossref","first-page":"60","DOI":"10.12691\/ajmcr-8-2-6","article-title":"Neurotoxicity associated with radiological contrast agents used during coronary angiography: a systematic review","volume":"8","author":"Kariyanna","year":"2020","journal-title":"Am J Med Case Rep"},{"key":"2026061608414672800_ytag416-B4","first-page":"97","article-title":"Contrast-induced spinal myoclonus after percutaneous coronary intervention","volume":"16","author":"Abela","year":"2017","journal-title":"J Cardiol Cases"},{"key":"2026061608414672800_ytag416-B5","article-title":"Contrast-induced neurotoxicity: an inside look at a rare presentation","volume":"14","author":"Gregory","year":"2022","journal-title":"Cureus"},{"key":"2026061608414672800_ytag416-B6","doi-asserted-by":"crossref","first-page":"957779","DOI":"10.3389\/fcvm.2022.957779","article-title":"An unusual contrast-induced encephalopathy following percutaneous coronary intervention in patients with cerebrovascular abnormalities: a case report","volume":"9","author":"Liao","year":"2022","journal-title":"Front Cardiovasc Med"}],"container-title":["European Heart Journal - 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