Objective: To report a post-operative, transient non-infectious, but symptomatic, brain edema surrounding the deep brain stimulation (DBS) electrode that resolved without intervention.

Background: Potential hardware complications that can occur as a result of DBS placement may be due to different causes like device-related failures, device displacement, infections etc.

Methods: We present a 67-year-old right-handed man with history of idiopathic Parkinson’s disease 25 years of evolution, who was admitted for the placement of bilateral Boston Scientific’s multiple source current-controlled DBS system (Vercise®) in the Subthalamic Nucleus (STN). He underwent the procedure using local anesthesia and sedation. MER was performed using micro-electrode. After the procedure the patient improved significantly in all motor items including dyskinesia and painful dystonia.

Results: One month after surgery, the patient was admitted to emergency room with a sharp deterioration in the previous week, complaining of clumsiness, mild confussion and urinary incontinence. DBS system was checked with optimum load level, but a significant drop on left impedances 300-400 Ω / 900-100 Ω on the right. CT head scan was obtained and revealed a large hypodense area souronding the left DBS electrode extending from the left frontal cortex to the subcortical region adyacent to frontal ventricular horn. No local or systemic signs or symptoms of infection were present, but mild fever, the first two days. CFS was normal. Gram stain, fungal stain and bacterial cultures, were negative. A cerebral MRI was obtained without sings of abcese or cerebritis signs. The clinical symptoms improved to baseline over the next week and the impedance values return to normal values. A new CT head scan obtained 2 weeks later showed resolution of the edema.

Conclusions: -Transient peri-electrode edema after DBS is an unusual complication. Quick and favorable resolution of the process, even without treatment, cautions against any decision to explant the electrode, in the absence of any obvious signs of infection. MRI may be useful in the diagnosis of post DBS complications. To confirm the safety of this procedure with VERCISE ® system are needed most cases.

This case was presented as poster in the anual Spanish Society of Neurology meetting (novembre 2015).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/transient-symptomatic-non-infectious-hypodensity-around-deep-brain-stimulation-electrode/