Abstract
BackgroundSymptomatic peri-lead edema is a rare complication of deep brain stimulation that has been reported to develop 4 to 120 days postoperatively.Case presentationHere we report the case of a 63-year-old Hispanic man with an 8-year history of Parkinson’s disease who underwent bilateral placement of subthalamic nucleus deep brain stimulation leads and presented with acute, symptomatic, unilateral, peri-lead edema just 33 hours after surgery.ConclusionsWe document a thorough radiographic time course showing the evolution of these peri-lead changes and their regression with steroid therapy, and discuss the therapeutic implications of these findings. We propose that the unilateral peri-lead edema after bilateral deep brain stimulation is the result of severe microtrauma with blood–brain barrier disruption. Knowledge of such early manifestation of peri-lead edema after deep brain stimulation is critical for ruling out stroke and infection and preventing unnecessary diagnostic testing or hardware removal in this rare patient population.
Highlights
ConclusionsWe document a thorough radiographic time course showing the evolution of these peri-lead changes and their regression with steroid therapy, and discuss the therapeutic implications of these findings
Symptomatic peri-lead edema is a rare complication of deep brain stimulation that has been reported to develop 4 to 120 days postoperatively.Case presentation: Here we report the case of a 63-year-old Hispanic man with an 8-year history of Parkinson’s disease who underwent bilateral placement of subthalamic nucleus deep brain stimulation leads and presented with acute, symptomatic, unilateral, peri-lead edema just 33 hours after surgery
In this report we are the first to present a case of symptomatic peri-lead edema appearing 33 hours after Deep brain stimulation (DBS) surgery, nearly 3 days earlier than previously published in the literature
Summary
The clinical relevance of this report lies in the need for the medical community, whether in the emergency room or movement disorders clinic, to recognize this pathology and distinguish it from ischemic stroke or postoperative infection, which require further diagnostic testing or surgery. Previous surgical interventions in symptomatic patients with peri-lead edema and cysts have included lumbar puncture, fluid tap from the surgical site, cyst aspiration, and lead removal, typically yielding no evidence of infection [4, 10]. In addition to preventing unnecessary interventions, increased awareness of this pathology will allow us to improve our study of the etiology and relevance of this rare complication
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