Delayed Stroke in Globus Pallidus Internus Deep Brain Stimulation

Deep brain stimulation (DBS) is a common neurosurgical treatment for movement and neuropsychiatric disorders refractory to medical treatment.Common DBS targets for Parkinson's disease include subthalamic nucleus, globus pallidus pars interna (GPi), and ventral intermediate nucleus of the thalamus.Known complications following deep brain stimulator placement include infection, intracranial and intraventricular hemorrhage (IVH), system failure, seizures, stroke and, depending on the location of stimulation, cognitive, behavioral, and motor complications. 1 There are no prior reports of delayed stroke following DBS placement.A 59-year-old female was admitted for elective bilateral GPi DBS for tardive dyskinesia.She had an 8-year history of tardive dyskinesia refractory to medical management (tetrabenazine 37.5 mg PO HS).Her past medical history included hypertension, hyperlipidemia, diabetes mellitus insulin dependent, hypothyroidism, previous oral contraceptive pill-associated deep vein thrombosis, chronic pain, and anxiety.She was on rosuvastatin, clonazepam, amitriptyline, tetrabenazine, rabeprazole, metformin, jardiance, synthroid, sertraline, and acetylsalicylic acid (ASA).She underwent bilateral GPi DBS.ASA was held for 5 days pre-operatively.Stage I was done awake with some remifentanil given for positioning.The patient was not confused during any portion of the procedure.Planning was done with a pre-operative MRI.The planned trajectory did not pass through any major vascular structures or into the ventricle.We obtained O-arm spin which was merged with the pre-operative MRI and obtained coordinates for the Cosman-Roberts-Wells frame.Burr holes were done as planned, and no cortical veins were coagulated.We used three microelectrode tracts for navigation, which were adjusted by the neurophysiologist who was monitoring the recordings.We then placed the lead and confirmed positioning using intraoperative X-ray.Stage II was done under general anesthetic with precedex and remifentanil.Systolic blood pressure (SBP) remained within 105-140 mmHg, with no instability.On POD#1, she was found to have a GCS of 14.She was on 4L nasal prongs with an SBP of 96.CT showed a small IVH (Figure 1A).Her Glasgow Coma Scale (GCS) declined to 12 on POD#2, and further to a GCS of 9 late in the day.She became drowsier, confused, less verbal, and developed new left-sided hemiparesis.Laboratory studies were unremarkable.Repeat CT showed bilateral caudate and right internal capsule stroke (Figure 1B).CTA showed no vascular injury or vessel occlusion.She was seen by inpatient neurology, who medically optimized her.Ultimately, she required extensive physical and occupational therapy followed by transfer to inpatient rehabilitation.She recovered well at rehab and was discharged home independently.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.