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Bilateral subcortical peri-electrode edema following GPi Deep Brain Stimulation surgery: case report
EANS Academy. Matos D. 09/26/19; 276180; EP07011
Dr. Daniela Matos
Dr. Daniela Matos

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Abstract
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Deep Brain Stimulation is a well established and important treatment for several brain disorders, namely movement disorders.
Although some complications such as hemorrhage and infection are known to occur at predictable rates, a much rarer and intriguing finding is that of non-infectious transient peri-electrode edema surrounding DBS leads.
We describe a case of bilateral peri-electrode edema, diagnosed on post-operative (72h after surgery) CT scan, in a 23 year-old patient submitted to bilateral GPi stimulation due to generalized dystonia secondary to PANK 4 deficiency. The patient was fully asymptomatic and stimulation was successful in alleviating dystonia. Peri-electrode edema presented as a hypodense area of approximately 2,5cm diameter in the subcortical region bilaterally, with no contrast enhancement. There where no local inflammatory signs and no systemic infectious markers. Patient course was uneventful and serial imaging showed progressive weaning and full resolution of the edema.
Literature review disclosed 25 cases of reported peri-electrode edema; in only one of them was the edema bilateral and, in such case, the area was much smaller and in a deeper location; the usual imaging characteristics are non-enhancing hypodensity on CT and hyperintensity on T2 MRI. Patients are usually asymptomatic or can present with headache, local pain/tenderness or even seizures. Treatment options are observation with or without steroid and the course is usually benign.
Our case is the first reported with bilateral subcortical peri-electrode edema and demonstrates the importance of early post-operative imaging, even in asymptomatic patients.
Deep Brain Stimulation is a well established and important treatment for several brain disorders, namely movement disorders.
Although some complications such as hemorrhage and infection are known to occur at predictable rates, a much rarer and intriguing finding is that of non-infectious transient peri-electrode edema surrounding DBS leads.
We describe a case of bilateral peri-electrode edema, diagnosed on post-operative (72h after surgery) CT scan, in a 23 year-old patient submitted to bilateral GPi stimulation due to generalized dystonia secondary to PANK 4 deficiency. The patient was fully asymptomatic and stimulation was successful in alleviating dystonia. Peri-electrode edema presented as a hypodense area of approximately 2,5cm diameter in the subcortical region bilaterally, with no contrast enhancement. There where no local inflammatory signs and no systemic infectious markers. Patient course was uneventful and serial imaging showed progressive weaning and full resolution of the edema.
Literature review disclosed 25 cases of reported peri-electrode edema; in only one of them was the edema bilateral and, in such case, the area was much smaller and in a deeper location; the usual imaging characteristics are non-enhancing hypodensity on CT and hyperintensity on T2 MRI. Patients are usually asymptomatic or can present with headache, local pain/tenderness or even seizures. Treatment options are observation with or without steroid and the course is usually benign.
Our case is the first reported with bilateral subcortical peri-electrode edema and demonstrates the importance of early post-operative imaging, even in asymptomatic patients.
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