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Case Reports
. 2017 Apr 14;11(1):103.
doi: 10.1186/s13256-017-1275-6.

Acute symptomatic peri-lead edema 33 hours after deep brain stimulation surgery: a case report

Nathan B Schoen  1 , Walter J Jermakowicz  2 , Corneliu C Luca  3 , Jonathan R Jagid  2
Affiliations
Case Reports

Acute symptomatic peri-lead edema 33 hours after deep brain stimulation surgery: a case report

Nathan B Schoen et al. J Med Case Rep. .

Abstract

Background: 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.

Conclusions: We 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.

Keywords: Case report; Parkinson’s disease; Steroids; Surgical complication.

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Figures

Fig. 1
Fig. 1
Radiographic time course of peri-lead edema. a Coronal and axial slices of computed tomography obtained 1 hour after surgery with no evidence of edema. b Computed tomography obtained 33 hours after surgery demonstrating evolving left peri-lead edema, especially along the proximal third of the deep brain stimulation lead. c T2-weighted MRI sequences obtained 46 hours after surgery showing significant peri-lead edema extending the entire length of the left lead. d Computed tomography obtained 8 days after surgery showing normal postoperative changes with no evidence of peri-lead edema. The white arrows highlight the peri-lead edema. Scale bar – 1 cm. A anterior, L lateral, M medial, S superior
See this image and copyright information in PMC

References

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