Severe aggressive acute disseminated encephalomyelitis-like reaction after aneurysm coiling

Neurointerventional procedures are the first choice of treatment for a variety of cerebrovascular pathologies in many centers worldwide. Although less invasive than conventional traditional surgical approaches, interventional procedures are not exempt from complications. We describe a case of an unusual complication after a coiling procedure where the patient developed severe brain edema induced by contrast media and resembling an aggressive acute disseminated encephalomyelitis-like reaction that was reversed with appropriate therapy.

A 53-year-old, right-handed woman presented with an incidental 4 x 6-mm anterior communicating complex aneurysm, which was successfully coiled with balloon assistance. On the third postcoiling day, she presented to the emergency department with global aphasia, dysarthria, right upper motor neuron pattern facial paresis, and right hemiplegia and hemianesthesia.

The initial intervention was a microballoon-assisted coiling of the anterior communicating complex aneurysm. The intervention for the subsequent complication was high-dose intravenous methylprednisolone for 5 days followed by slow tapering of oral prednisolone. At a 4-month follow-up examination, the patient was asymptomatic and neurologically intact.

We present a case of an unusual complication after a coiling procedure. Considering that endovascular interventional procedures are part of the therapeutic armamentarium for cerebrovascular pathologies, it is of fundamental importance to increase awareness of potential complications that could arise from such interventions.