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Published on: January 6, 2011
Acute symptomatic peri-lead edema 33 hours after deep brain stimulation surgery: a case report
Nathan B Schoen1, Walter J Jermakowicz2, Corneliu C Luca3
1Department of Neurological Surgery, University of Miami Miller School of Medicine, 1150 NW 14th St., Miami, Florida, 33136, USA. nschoen@med.miami.edu.
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.
