Longitudinal Neuropsychological Assessment of Symptomatic Edema after Subthalamic Nucleus Deep Brain Stimulation Surgery: A Case Series Study

IF 3.2 Q2 CLINICAL NEUROLOGY
Silvia De Ieso, Giulia Di Rauso, F. Cavallieri, Daniela Beltrami, Alessandro Marti, Manuela Napoli, R. Pascarella, A. Feletti, V. Fioravanti, Giulia Toschi, Vittorio Rispoli, Francesca Antonelli, Annette Puzzolante, Giacomo Pavesi, F. Gasparini, Franco Valzania
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Abstract

Severe non-infectious or non-haemorrhagic brain edema surrounding the electrode represents a rare complication of subthalamic nucleus deep brain stimulation (STN-DBS) surgery. The aim of this study is to report three patients with advanced Parkinson’s Disease (PD) who developed symptomatic brain edema after STN-DBS surgery treated with intravenous steroids with a specific profile of reversible cognitive alterations. Patients were both assessed with a comprehensive neuropsychological battery including attention, memory, visuo-spatial and executive tasks. They were also briefly assessed for emotional and behavioural alterations, and for possible limitations in the activities of daily living. Normative data for an Italian population were available for all neuropsychological tests. The patients were firstly assessed before the surgery (baseline) as soon as they became symptomatic for the post-surgery edema and a few more times in follow-up up to ten months. In all patients we observed the resolution of cognitive deficits within six months after surgery with the corresponding reabsorption of edema at brain CT scans. The appearance of post-DBS edema is a fairly frequent and clinically benign event. However, in some rare cases it can be very marked and lead to important clinical—albeit transient—disturbances. These events can compromise, at least from a psychological point of view, the delicate path of patients who undergo DBS and can prolong the post-operative hospital stay. In this setting it could be helpful to perform a brain CT scan in 2–3 days with the aim of detecting the early appearance of edema and treating it before it can constitute a relevant clinical problem.
眼下核深部脑刺激手术后症状性水肿的纵向神经心理学评估:病例系列研究
电极周围严重的非感染性或非出血性脑水肿是眼下核深部脑刺激(STN-DBS)手术的罕见并发症。本研究旨在报告三名晚期帕金森病(PD)患者,他们在接受静脉类固醇治疗 STN-DBS 手术后出现症状性脑水肿,并伴有可逆的认知改变。患者均接受了全面的神经心理学评估,包括注意力、记忆力、视觉空间和执行任务。此外,还对患者的情绪和行为改变以及日常生活活动可能受到的限制进行了简要评估。所有神经心理学测试都有意大利人口的标准数据。手术前(基线),一旦患者出现手术后水肿症状,我们就会立即对其进行评估,并在长达 10 个月的随访期间对其进行多次评估。我们观察到,所有患者的认知障碍都在术后 6 个月内得到了缓解,脑 CT 扫描中的水肿也得到了相应的吸收。脑震荡后水肿的出现是一种相当常见的临床良性现象。但在一些罕见病例中,水肿可能非常明显,并导致重要的临床(尽管是短暂的)障碍。至少从心理角度来看,这些事件会影响接受 DBS 治疗的患者的微妙状态,并延长术后住院时间。在这种情况下,最好在 2-3 天内进行一次脑 CT 扫描,以便及早发现水肿,并在其成为相关临床问题之前进行治疗。
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来源期刊
Neurology International
Neurology International CLINICAL NEUROLOGY-
CiteScore
3.70
自引率
3.30%
发文量
69
审稿时长
11 weeks
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