An unusual early and persistent symptomatic presentation of peri-lead edema following deep brain stimulation: Case report and literature review

Abstract

Background

Peri-lead edema (PLE) following deep brain stimulation surgery is apparently a common, self-limiting condition. PLE generally occurs within days to weeks, rarely occurring before postoperative day one. Majority of patients are asymptomatic, although a wide range of sings/symptoms may be present.

Case description

A 62-year-old female patient with Parkinson’s Disease underwent DBS of the subthalamic nucleus in November 2018. Asymptomatic, the patient presented bilateral PLE in the immediate post-operative CT. After two weeks, she developed a frontal lobe dysfunction and persistence of PLE in MRI. She underwent a three-week course of dexamethasone, with mild improvement. However, she subsequently fell at home in January 2019, sustaining an injury to the scalp over the connection site surgical incision. Due to persisting PLE, this was managed with a new course of Dexamethasone, and she was followed-up with CT scans. Two months later (March 2019) the patient presented with urinary tract infection and a lateral scalp erosion over the lead’s connection site. Debridement and primary closure of the skin were performed, followed by a four-week vancomycin course. A MRI at the stage showed marked improvement of the edema. The most recent MRI (May 2019) and CT scan (July 2019) showed resolution of the edema.

Conclusions

We reported an atypical case of ultra early and persistent PLE presentation following DBS surgery, which improved with courses of steroids. It is unknown whether steroids have a role in the management of PLE.