gms | German Medical Science

72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Delayed leukoencephalopathy and foreign body reaction after endovascular treatment in patients with intracranial aneurysms and aneurysmal subarachnoid haemorrhage – systematic review of the literature and a recent case

Sekundäre Leukoenzephalopathie und Fremdkörperreaktion nach endovaskulärer Behandlung von Patienten mit intrakraniellen Aneurysmen und aneurysmatischer Subarachnoidalblutung – Literaturübersicht und Fallvorstellung

Meeting Abstract

  • presenting/speaker Sami Ridwan - Klinikum Ibbenbüren, Neurochirurgie, Ibbenbüren, Deutschland; Paracelsus-Klinik Osnabrück, Klinik für Neurochirurgie, Osnabrück, Deutschland
  • Jörg Andreas Kandyba - Marienhospital Osnabrück, Osnabrück, Deutschland
  • Anita Schug - Paracelsus-Klinik Osnabrück, Klinik für Neurochirurgie, Osnabrück, Deutschland
  • Elina Malsagov - Paracelsus-Klinik Osnabrück, Klinik für Neurochirurgie, Osnabrück, Deutschland
  • Nikolaos Karageorgos - Klinikum Ibbenbüren, Neurochirurgie, Ibbenbüren, Deutschland; Paracelsus-Klinik Osnabrück, Klinik für Neurochirurgie, Osnabrück, Deutschland
  • Franz-Josef Hans - Klinikum Ibbenbüren, Neurochirurgie, Ibbenbüren, Deutschland; Paracelsus-Klinik Osnabrück, Klinik für Neurochirurgie, Osnabrück, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP184

doi: 10.3205/21dgnc465, urn:nbn:de:0183-21dgnc4651

Published: June 4, 2021

© 2021 Ridwan et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Delayed leukoencephalopathy and foreign body reaction are rare complications after endovascular treatment of intracranial aneurysms. However, cases are increasingly being described. Here we present a systematic review of the pertinent literature and an illustrative case.

Methods: Clinical presentation, differentials, diagnostics and treatment as well as formerly published data were reviewed in light of a recent case. A systematic search of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Results: We provide an extensive literature review and discuss causes and management of this rare delayed complication. Furthermore, we present the case of a 53-year-old female patient with a subarachnoid hemorrhage from a large anterior communicating artery aneurysm with tortuous cervical vessels who was treated with endovascular coiling. Post-Coiling MRI revealed partial anterior cerebral artery ischemia and scattered ischemic micro-emboli in the left central cortex. At discharge most symptoms were already resolved. Rehospitalization was necessary due to recurrent deterioration of the known symptoms six weeks after transfer to rehabilitation. A CT scan revealed substantial left hemispheric edema. MRI and MR-Angiography confirmed extensive vasogenic edema with contrast enhancing predominantly cortical lesions (Figure 1 A - C [Fig. 1]) in the left ICA territory and no novel vascular obliteration. The patient recovered timely under high dose corticosteroid treatment and follow up MRI showed almost complete remission of the described lesions within 10 days (Figure 1 D [Fig. 1]). Follow up MRI after 3 months demostrated almost complete remission (Figure 2 [Fig. 2]).

Conclusion: Foreign body reaction might result in delayed leukoencephalopathy, especially following complex endovascular aneurysm treatment. Early high dose followed by low dose ongoing corticosteroid treatment might result in timely remission.