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Intracerebral abscess: a rare complication of Deep Brain Stimulation
Eva Brandão1, Maria José Rosas, Pedro Abreu
1Department of Neurology, Hospital de S. Sebastião, Santa Maria da Feira, Portugal.
Introduction:
Deep Brain Stimulation (DBS) is a therapeutic option for some forms of Parkinson's disease (PD). The main adverse effects of this surgery are: infection (2-9%), haemorrhage (1-4%) and seizures (1-3%). We report a rare complication of DBS: an intracranial abscess.
Case Report:
A 59-year-old male who had suffered PD for 19 years was submitted to bilateral subthalamic nucleus DBS in September 2003, when he was 52. One month later, he developed an inflammatory reaction of the skin and subcutaneous tissue surrounding the area of the subcutaneous DBS system. No infectious agent was isolated. In the following 12 months he required 5 major surgeries due to a process of systematic inflammation/infection throughout different locations of the DBS system. A few days after removal of the DBS device, he developed a right oculomotor nerve paresis and mild left hemiparesis. A CT scan revealed an abscess in the right thalamo-mesencephalic area. Both the new neurological deficits and the previous tremor and rigidity improved after surgical drainage and medical treatment.
Conclusion:
This case report illustrates a rare complication of DBS surgery. Nevertheless, Parkinsonism improved, probably because the abscess acted like a subthalomotomy.
Insights
A rare intracranial abscess complication occurred after Deep Brain Stimulation (DBS) for Parkinson's disease. Surgical drainage improved both the abscess and Parkinsonism symptoms.
Area of Science:
- Neurosurgery
- Neurology
Background:
- Deep Brain Stimulation (DBS) is a treatment for Parkinson's disease (PD).
- Common adverse effects include infection, hemorrhage, and seizures.
- This case highlights a rare intracranial abscess complication.
Observation:
- A 59-year-old male with 19 years of PD underwent bilateral subthalamic nucleus DBS.
- He developed a skin inflammatory reaction, followed by systemic inflammation/infection of the DBS system over 12 months.
- Following DBS device removal, he experienced oculomotor nerve paresis and hemiparesis, with CT revealing a thalamo-mesencephalic abscess.
Findings:
- The intracranial abscess was surgically drained and medically treated.
- Neurological deficits and Parkinsonian symptoms (tremor, rigidity) improved post-treatment.
- The abscess may have induced a therapeutic effect similar to subthalomotomy.
Implications:
- This case underscores the possibility of rare intracranial abscesses following DBS surgery.
- Effective management involves surgical drainage and medical treatment.
- The unexpected therapeutic benefit suggests potential alternative mechanisms in PD management.
