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Case Reports
. 2023 Jan 7;12(2):496.
doi: 10.3390/jcm12020496.

Delayed Leucoencephalopathy as a Complication after Endovascular Therapy of Intracranial Aneurysms-A Case Series

Eleni Bakola  1 , Georgia Papagiannopoulou  1 , Lina Palaiodimou  1 , Konstantinos Lagios  2 , Eftychios Archontakis  3 , Aikaterini Theodorou  1 , Aristeidis H Katsanos  4 , Sokratis Triantafyllou  1 , Vasiliki Zouvelou  5 , Stefanos Lachanis  6 , Dimitrios Tzanetakos  1 , John S Tzartos  1 , Sotirios Giannopoulos  1 , Georgios Tsivgoulis  1   7
Affiliations
Case Reports

Delayed Leucoencephalopathy as a Complication after Endovascular Therapy of Intracranial Aneurysms-A Case Series

Eleni Bakola et al. J Clin Med. .

Abstract

We describe the clinical presentation, radiological findings, treatment and outcomes of three patients with delayed leukoencephalopathy occurring after endovascular treatment (EVT) for cerebral aneurysms-a rare, albeit recurring, complication. The symptoms occurred 6 to 12 months following the EVT of the cerebral aneurysm. Characteristic imaging findings included high-signal changes on T2 images in the white matter without diffusion restriction predominantly at the distribution of the vascular territory of the catheterized arteries, coupled with patchy gadolinium enhancement or low susceptibility weighted imaging (SWI) signals within the white-matter lesions. Steroid pulse therapy is the treatment of choice and promptly improves clinical and imaging findings. Tapering or cessation of steroids may result in clinical and imaging relapses; close- and long-term follow-up for patients presenting this complication is warranted.

Keywords: case series; endovascular treatment; enhancing white matter lesions; immune reaction; intracranial aneurysm.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Timeline overview of three cases. Arrows suggest steroid treatment.
Figure 2
Figure 2
Imaging findings of case 1. Axial fluid-attenuated inversion recovery (FLAIR) sequence demonstrating white-matter hyperintensities right temporoparietal (A); Low-signal spots in axial SWI ((B); dotted circle). Follow-up MRI one month later with substantial resolution of the white matter hyperintensities in axial FLAIR sequence ((C); arrow); Recurrence of white-matter hyperintensities on axial FLAIR image two years later ((D); dotted circle).
Figure 3
Figure 3
Imaging findings of case 2. White-matter hyperintensities right parietoccipital in axial FLAIR sequence ((A); arrows); Gadolinium-enhancement of the lesions in axial T1-weighted image ((B); arrows). Follow-up MRI one year later demonstrating slight vasogenic edema remission on axial FLAIR sequence (C); Significant improvement in axial T1-weighted image showing only slight Gd enhancement ((D); arrows).
Figure 4
Figure 4
Imaging findings of case 3. FLAIR image with white matter lesions in the left hemisphere (A); Axial T1-weighted image showing intense Gd-enhancement ((B); arrows). Both axial FLAIR- sequence ((C); dotted circle) and axial T1-weighted image ((D); arrows) show radiological improvement one month later.
See this image and copyright information in PMC

References

    1. Wang A.S., Campos J.K., Colby G.P., Coon A.L., Lin L.M. Cerebral aneurysm treatment trends in National Inpatient Sample 2007–2016: Endovascular therapies favored over surgery. J. Neurointerv. Surg. 2020;12:957–963. doi: 10.1136/neurintsurg-2019-015702. - DOI - PubMed
    1. Pierot L., Wakhloo A.K. Endovascular treatment of intracranial aneurysms: Current status. Stroke. 2013;44:2046–2054. doi: 10.1161/STROKEAHA.113.000733. - DOI - PubMed
    1. Ikemura A., Ishibashi T., Otani K., Yuki I., Kodama T., Kan I., Kato N., Murayama Y. Delayed Leukoencephalopathy: A Rare Complication after Coiling of Cerebral Aneurysms. AJNR Am. J. Neuroradiol. 2020;41:286–292. doi: 10.3174/ajnr.A6386. - DOI - PMC - PubMed
    1. Bakola E., Katsanos A.H., Palaiodimou L., Theodorou A., Stefanou M.I., Chondrogianni M., Andreadou E., Papadopoulou M., Konstantakos V., Voumvourakis K., et al. Delayed recurrent enhancing white matter lesions complicating coiling of intracranial aneurysm. Eur. J. Neurol. 2021;28:2388–2391. doi: 10.1111/ene.14844. - DOI - PubMed
    1. Shotar E., Law-Ye B., Baronnet-Chauvet F., Zeidan S., Psimaras D., Bielle F., Pecquet C., Navarro S., Rosso C., Cohen F., et al. Non-ischemic cerebral enhancing lesions secondary to endovascular aneurysm therapy: Nickel allergy or foreign body reaction? Case series and review of the literature. Neuroradiology. 2016;58:877–885. doi: 10.1007/s00234-016-1699-5. - DOI - PubMed

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