Delayed intracranial hemorrhage following deep brain stimulation for Parkinson's disease: illustrative case

Delayed symptomatic postoperative intracranial hemorrhage (ICH) is an uncommon yet consequential complication of deep brain stimulation (DBS) device implantation surgery, previously defined as occurring after postoperative day 1 and uncommonly reported to occur months after surgery. Recognizing this entity may be critical for optimizing patient management, despite its rarity.

A 73-year-old woman with Parkinson's disease underwent bilateral subthalamic nucleus (STN) DBS device implantation without perioperative complications. She presented 4 months later after ascending by automobile to a high altitude, during which she experienced acute left facial droop, ptosis, slurred speech, balance changes, and horizontal diplopia. MRI revealed a left-sided 1-cm3 hematoma at the tip of the left DBS lead, centered in the STN. She was admitted for 2 days of inpatient observation. She returned to her neurological baseline 2 weeks after discharge and remains symptomatically stable.

Delayed ICH after DBS is rarely reported, yet it can result in significant neurological deficits. Multiple etiologies may be possible for delayed ICH after DBS. This patient's exposure to high altitude at symptom onset, an independent risk factor for cerebral edema and hypercoagulability, may have contributed to this rare event. https://thejns.org/doi/10.3171/CASE26401.