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Brain abscess in a patient with generalized dystonia after deep brain stimulation: illustrative case
Masami Nakamura1, Tomoyuki Maruo1,2, Hiroaki Hashimoto1,3
11Department of Neurosurgery, KKR Otemae Hospital, Osaka, Japan.
Background:
Infections related to deep brain stimulation (DBS) devices are not rare, but abscess formation in brain parenchyma is extremely rare.
Observations:
A 50-year-old man with generalized dystonia had undergone DBS of bilateral globus pallidus internus. The authors attempted to remove the bilateral DBS system due to repeated device infections caused by metal allergies. However, the intracranial lead had to be left in place, because the lead was strongly adherent to brain parenchyma. Five years later, magnetic resonance imaging showed ring-like enhancement localized around the tip of the intracranial lead, suggesting brain abscess. In response to the symptoms, the remaining left intracranial electrode was removed. Brain abscesses require several months of treatment with appropriate antibiotics, but good outcomes can be achieved with appropriate treatment.
Lessons:
Brain abscess is a rare complication of DBS. In the present case, the infection spread from the subcutaneous infected foci to the intracranial area through the lead, resulting in the formation of a brain abscess. Removing as much of the device as possible from the body is therefore important, even if adhesions with brain parenchyma or other tissues are present, because of the risk of serious complications, as seen in this case.
Insights
Deep brain stimulation (DBS) infections are uncommon, with brain abscesses being exceptionally rare. This case highlights the risk of infection spread through implanted DBS leads, emphasizing complete device removal to prevent serious complications.
Area of Science:
- Neurology
- Neurosurgery
- Infectious Disease
Background:
- Deep brain stimulation (DBS) is a treatment for movement disorders.
- Infections associated with DBS devices are known but typically do not involve brain abscess formation.
- Metal allergies can necessitate DBS device removal.
Purpose of the Study:
- To report an extremely rare case of brain abscess formation secondary to a deep brain stimulation device.
- To discuss the potential for infection to spread intracranially through DBS leads.
- To emphasize the importance of complete device removal in managing DBS-related infections.
Main Methods:
- A case study of a 50-year-old male with generalized dystonia undergoing DBS.
- Attempted removal of a bilateral DBS system due to recurrent infections from metal allergies.
- Management of a delayed brain abscess diagnosis via surgical removal of the remaining intracranial lead.
Main Results:
- A brain abscess developed five years after DBS implantation, indicated by MRI findings.
- The infection likely spread from subcutaneous foci along the retained intracranial lead.
- Successful treatment of the brain abscess was achieved after removal of the remaining lead and antibiotic therapy.
Conclusions:
- Brain abscess is a rare but serious complication of DBS.
- Infection can disseminate intracranially through adhered DBS leads, even years after implantation.
- Complete removal of DBS hardware, despite tissue adherence, is crucial to mitigate risks of severe complications.
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