Development of Unilateral Peri-Lead Edema Into Large Cystic Cavitation After Deep Brain Stimulation: A Case Report
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Background and Importance Deep brain stimulation (DBS) has been approved to treat a variety of movement disorders, including Parkinson's disease (PD), essential tremor, and dystonia. Following the DBS surgery, some perioperative and even delayed complications due to intracranial and hardware-related events could occur, which may be life-threatening and require immediate remedial measures. Clinical Presentation We report a case of an older woman with advanced PD who developed the unique complication of unilateral cyst formation at the tip of the DBS electrode after undergoing bilateral placement of subthalamic nucleus DBS. After a period of controlled motor symptoms, the patient showed new neurological deficits related to right peri-lead edema. However, the new neurological symptoms regressed quickly over several days with stereotactic implantation of a puncture needle to drain the cyst fluid without removing the affected lead. Conclusion The occurrence of an intraparenchymal cyst following DBS surgery is a rare but life-threatening complication that could relate to edema around the electrodes or cerebrospinal fluid tracking. Stereotactic aspiration makes the intracranial cyst regress safely and effectively and ensures that the electrode is in the optimal position of the target nucleus to achieve an effective DBS surgery.Keywords:
Peri
Brain Edema
Lead (geology)
Objective: Prediction of delayed brain edema after spontaneous intracerebral hemorrhage by magnetic resonance spectroscopy combined with diffusion weighted imaging, and to explore the causes and treatment of delayed brain edema after intracerebral hemorrhage. Methods: The patients with spontaneous cerebral hemorrhage diagnosed by CT from January 2015 to June 2018 in our hospital were analyzed. Magnetic resonance spectroscopy and diffusion weighted imaging examinations were performed on the third day after hemorrhage. It was diagnosed as delayed brain edema that the edema range enlarged more than 1 cm in CT scan on the 14th day Compare with the 7th Day. The patients were divided into the delayed brain edema group and the control group(n=27 for each). The NAA/Cr value and rADC value of the edema area in the two groups were analyzed by T test. Results: The NAA/Cr value (1.67±0.38) in the edema area of patients with delayed brain edema was significantly decreased Compare with the control group(1.92±0.42), and the rADC value (2.59±0.42) reduced significantly Compare with the control group (2.93±0.51), the differences were statistically significant (P<0.05). Conclusion: MRS and DWI were susceptive in showing delayed brain edema lesions at hyper-early phase. Combination of MRS and DWI can provide a basis for clinical individual treatment programs selection and prognostic evaluation.目的： 通过磁共振波谱成像联合弥散加权成像技术预测自发性脑出血后迟发性脑水肿的发生，并探讨该病的发生原因及防治措施。 方法： 对湖州市第一人民医院2015年1月至2018年6月收治的头颅CT提示为自发性脑出血的患者进行分析。入院后第3天常规行MRS及DWI检查，动态CT证实14 d内脑内血肿周围水肿较7 d水肿周边直径增大1 cm以上诊断为迟发性脑水肿，设为观察组（27例），未并发迟发性脑水肿的脑出血患者设为对照组（27例），对两组患者水肿区域NAA/Cr值以及rADC值进行统计分析。 结果： 自发性脑出血迟发性水肿患者水肿区域NAA/Cr值（1.67±0.38）较对照组NAA/Cr值（1.92±0.42）明显降低，rADC值（2.59±0.42）较对照组rADC值（2.93±0.51）明显降低，差异均有统计学意义（均P<0.05）。 结论： 通过MRS的脑水肿区域NAA/Cr比值以及DWI检查的rADC值的统计差异变化，可以指导预判自发性脑出血后迟发性脑水肿的发生，更具客观性及科学性。.
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Objective: To probe whether the secondary brain edema would get heavy on the patients of spontaneous intracerebral hemorrhage(SICH),when the periods of mannitol were longer(more than 3 days and less than 7 days).Methods: Eight-two patients of SICH(volume more than 3 mL) were reviewed with CT scan within 24 h and 4-7 day after SICH onset.Based on the period of mannitol treatment is more than 3 days or not,the patients were divided into two groups compared the volume of secondary brain edema.Results: To compare the volume of secondary brain edema between the group of mannitol treatment period less than 3 days [(21.7±12.7)mL] and the group of mannitol treatment period more than 3 days [(27.7±17.8)mL],there is no statistical differences between two groups of the volume of secondary brain edema.Conclusion: A longer period(less than 7 days) of mannitol treatment wouldn't enlarge second-ary brain edema on patients with SICH.
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Abstract Background To review the incidence and extent of peri‐electrode edema after DBS and to clarify the effect of postoperative use of steroids on the peri‐electrode edema. Methods This retrospective cohort study included 250 patients who underwent bilateral subthalamic nucleus (STN) DBS surgery with intact MRI within 1 month after DBS surgery. Patients were divided into steroid and non‐steroid groups, based on postoperative steroids use. The occurrence and extent of peri‐electrode edema were compared between the two groups, and other associated factors were analyzed using univariate and multivariate methods. Results Peri‐electrode edema >1 cm 3 in at least one hemisphere was reported in 215 (86.00%) patients. The mean volume of peri‐electrode edema observed in the steroid group was significantly smaller than in the non‐steroid group (8.09 ± 8.47 cm 3 vs 17.10 ± 16.90 cm 3 , p < 0.001). In the steroid group, 104 (32.91%) of the 316 implanted electrodes present with edema less than 1 cm 3 , whereas in the non‐steroid group, only 27 (14.67%) of the 184 implanted electrodes present with edema less than 1 cm 3 ( p < 0.001). Multivariate analysis indicated that lesser peri‐electrode edema was significantly associated with postoperative steroids use and general anesthesia. Conclusions Peri‐electrode edema is common after DBS surgery, and postoperative steroids use reduces the occurrence and extent of peri‐electrode edema.
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To investigate the temporary profile of changing perifocal brain edema around an intracerebral hematoma (ICH), we developed an experimental ICH model using cats. The developing perifocal edema in the white matter around the hematoma was measured by means of a gravimetric technique. Edema was more severe near the ICH, and declined with increasing distance. Edema was mild 2 hours after the onset of the ICH, and was most severe in all the regions examined 3 days later. Edema decreased but still existed in all regions 7 days after the onset of the ICH. The results suggest that the mechanism of the development of edema associated with ICH seems to differ from that associated with a cold injury. This experimental ICH model proved to be useful for the study of formation, expansion, and resolution of edema associated with ICH.
Brain Edema
Cerebral edema
Intracerebral hematoma
Midline shift
Neuroradiology
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Brain Edema
Brain swelling
Cerebral edema
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Brain Edema
Brain tissue
Cerebral edema
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Objective To explore the relationship between plasma Tumor necrosis factor-alpha(TNF-α),Interleukin-6(IL-6) levels and brain edema caused by hypertensive intracerebral henorrhage.Methods 62 patients with hypertensive intrscerebral hemorrhage( the observation group) and 50 healthy persons( the control group) were selected.The expression of plasma TNF-α and IL-6 were determined by ELISA pre-therapy and 1d,3d,7d,14d after treatment in two groups;The volume of cerebral edema was measured by CT.The relationship between plasma TNF-α,IL-6 levels and brain edema caused by hypertensive intracerebral hemorrhage were analyzed.Results Before treatment,the levels of TNF-α and IL-6 in the observation group were( 15.62 ±9.49)μg/L and (67.47 ±6.31 )ng/L,which were significandy higher than(8.28 ± 3.36) μg/L and(31.02 ± 3.51 ) ng/L of the control group( t =9.17,64.28,P =0.01 ),and Spearman analysis showed that the levels of TNF-α and IL-6 were positively correlated with the volume of cerebral edema(r=0.934,P=0.02;r=0.922,P =0.026).Conclusion There was an up-regulation of TNF-α and IL-6 levels in the plasma of patients with hypertensive intracerebral hemorrhage.TNF-α and IL-6 may promote the formation of cerebral edema during the course of hypertensive intracerebral hemorrhage.
Key words:
Cerebral hemorrhage; Brain edema; Interleukin-6; Tumor necrosis factor-alpha
Brain Edema
Cerebral edema
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Objective To understand the relationship between clinical indicators and brain edema on the patients with spontaneous intracerebral hemorrhage(SICH).Methods 77 patients with SICH were checked by CT sean within 6 hours of onset or 4 days later.The ratitionships between brain edema degrees and clinical findings were analyseed.Results The patients with severe hypertention would suffer from more severe edema Diabetes mellitus,excessive smoking and drinking were not related with edema.Conclusions The edema on the patients with SICH is related to severe hypertension.
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Spontaneous intracerebral hemorrhage
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Objective To explore the evolving and vanishing time of brain edema after contusion and laceration in order to provide the guidance for clinically treating the brain edema. Methods The brain edma were judged according to a CT scan at least every 3 days in 174 patients with cerebral contusion and laceration. The change in the brain edema with the lapse of time were re-corded and analyzed. Results The brain edema in all the patients reached to the peak in 3 days after trauma, but the time of the brain edema peak was different among the patients. The peak of the brain edema lasted 3～5 days in 7 patients, 6～8 days in 34, 9～11 days in 112 and more than 12 days in 21. The time of the brain edema peak were significantly associated with the severity of trauma and brain edema. Conclusion The time of the brain edema peak revealed by the present study were longer than that we knew before in most of the patients with cerebral contusion and laceration; therefore the dehydrating agents should be longer administered and carefully selected according to their condition in the patients with cerebral injury, especially in one with severe brain contusion and laceration.
Brain Contusion
Brain Edema
Cerebral contusion
Cerebral edema
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