Pub Date : 2020-06-01DOI: 10.1093/med/9780190647209.003.0036
Mitesh Lotia
The past two decades have revealed substantial benefits of bilateral pallidal deep brain stimulation (DBS) in patients with medication-refractory primary dystonia. There is a growing body of evidence now describing not only short-term but also long-term benefits up to 10 years following DBS. These benefits are often sustained, requiring minimal long-term modification. Pallidal programming for dystonia may be complex owing to the gradual onset of benefits and often delayed development of side effects. There is a relative scarcity of evidence-based recommendations for standardized programming methods. This chapter reviews essential factors to consider for appropriate patient selection and discusses strategies for initial and follow-up programming. Finally, the chapter describes the potential short-term and long-term adverse effects, while considering various strategies to mitigate them.
{"title":"Deep Brain Stimulation for Dystonia","authors":"Mitesh Lotia","doi":"10.1093/med/9780190647209.003.0036","DOIUrl":"https://doi.org/10.1093/med/9780190647209.003.0036","url":null,"abstract":"The past two decades have revealed substantial benefits of bilateral pallidal deep brain stimulation (DBS) in patients with medication-refractory primary dystonia. There is a growing body of evidence now describing not only short-term but also long-term benefits up to 10 years following DBS. These benefits are often sustained, requiring minimal long-term modification. Pallidal programming for dystonia may be complex owing to the gradual onset of benefits and often delayed development of side effects. There is a relative scarcity of evidence-based recommendations for standardized programming methods. This chapter reviews essential factors to consider for appropriate patient selection and discusses strategies for initial and follow-up programming. Finally, the chapter describes the potential short-term and long-term adverse effects, while considering various strategies to mitigate them.","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"32 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72592294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-01DOI: 10.1093/med/9780190647209.003.0026
Pravin Khemani, Shilpa Chitnis
Deep brain stimulation (DBS) surgery–associated complications are most commonly due to infections and issues with surgical hardware. An uncommon postsurgical complication hindering effective programming is noninfectious edema appearing as an abnormal peri-electrode T2 signal hyperintensity on brain magnetic resonance imaging (MRI). A 72-year-old woman with Parkinson disease underwent bilateral subthalamic nucleus (STN) implantation for medication-refractory motor symptoms. Worsening balance shortly after surgery and suboptimal response to DBS programming prompted brain MRI, which showed an abnormal T2 hyperintensity around the left STN electrode. Although intravenous antibiotics were considered, the absence of clinical signs and lack of postcontrast T2 signal enhancement argued against infection. Suspecting vasogenic edema, a short course of oral dexamethasone steroids was initiated, with gradual improvement in balance and resolution of the abnormal MRI signal. The mechanism of steroid-responsive vasogenic edema after DBS surgery is not well-understood. This case underscores the importance of being vigilant about this rare complication, differentiating it from infection based on clinical presentation and radiographic characteristics, and treating it appropriately.
{"title":"Steroid-Responsive Edema Interfering With Deep Brain Stimulation Programming","authors":"Pravin Khemani, Shilpa Chitnis","doi":"10.1093/med/9780190647209.003.0026","DOIUrl":"https://doi.org/10.1093/med/9780190647209.003.0026","url":null,"abstract":"Deep brain stimulation (DBS) surgery–associated complications are most commonly due to infections and issues with surgical hardware. An uncommon postsurgical complication hindering effective programming is noninfectious edema appearing as an abnormal peri-electrode T2 signal hyperintensity on brain magnetic resonance imaging (MRI). A 72-year-old woman with Parkinson disease underwent bilateral subthalamic nucleus (STN) implantation for medication-refractory motor symptoms. Worsening balance shortly after surgery and suboptimal response to DBS programming prompted brain MRI, which showed an abnormal T2 hyperintensity around the left STN electrode. Although intravenous antibiotics were considered, the absence of clinical signs and lack of postcontrast T2 signal enhancement argued against infection. Suspecting vasogenic edema, a short course of oral dexamethasone steroids was initiated, with gradual improvement in balance and resolution of the abnormal MRI signal. The mechanism of steroid-responsive vasogenic edema after DBS surgery is not well-understood. This case underscores the importance of being vigilant about this rare complication, differentiating it from infection based on clinical presentation and radiographic characteristics, and treating it appropriately.","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"289 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74388986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-01DOI: 10.1093/med/9780190647209.003.0007
Vibhash D. Sharma, Shilpa Chitnis
Deep brain stimulation therapy is an effective therapy for selected patients with movement disorders. The procedure is relatively safe, but complications related to the surgical procedure or implanted hardware can occur. The common complications include hemorrhage, infarct, infection, and confusion. Noninfectious cyst formation around the DBS lead is a rare but potential complication of this procedure, which can occur several weeks to months after DBS lead implantation. This chapter describes a case of noninfectious cyst formation at the tip of DBS lead in a patient with essential tremor. Clinical presentation, role of imaging, and the management options for this rare complication are discussed. This case also illustrates the importance of post-DBS imaging in suspected cases with new or unexplained symptoms.
{"title":"Symptomatic Cystic Lesion Following Deep Brain Stimulation Surgery","authors":"Vibhash D. Sharma, Shilpa Chitnis","doi":"10.1093/med/9780190647209.003.0007","DOIUrl":"https://doi.org/10.1093/med/9780190647209.003.0007","url":null,"abstract":"Deep brain stimulation therapy is an effective therapy for selected patients with movement disorders. The procedure is relatively safe, but complications related to the surgical procedure or implanted hardware can occur. The common complications include hemorrhage, infarct, infection, and confusion. Noninfectious cyst formation around the DBS lead is a rare but potential complication of this procedure, which can occur several weeks to months after DBS lead implantation. This chapter describes a case of noninfectious cyst formation at the tip of DBS lead in a patient with essential tremor. Clinical presentation, role of imaging, and the management options for this rare complication are discussed. This case also illustrates the importance of post-DBS imaging in suspected cases with new or unexplained symptoms.","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81345261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-01DOI: 10.1093/med/9780190647209.003.0003
B. Bluett
Essential tremor (ET) is one of the most common movement disorders and can result in disabling symptoms that are refractory to standard medications. In 1997, the US Food and Drug Administration approved deep brain stimulation (DBS) of the ventral intermedius nucleus of the thalamus for treatment of ET. DBS often reduces or eliminates the need for medications to treat ET. Proper patient selection and expertise in DBS programming are critical to ensure optimal outcomes. Recent advances in DBS include directional current steering and multisource independent constant current to program each electrode with its own power source. This chapter discusses proper patient selection, programming guidelines, and clinical pearls in DBS for ET.
{"title":"Deep Brain Stimulation for Essential Tremor","authors":"B. Bluett","doi":"10.1093/med/9780190647209.003.0003","DOIUrl":"https://doi.org/10.1093/med/9780190647209.003.0003","url":null,"abstract":"Essential tremor (ET) is one of the most common movement disorders and can result in disabling symptoms that are refractory to standard medications. In 1997, the US Food and Drug Administration approved deep brain stimulation (DBS) of the ventral intermedius nucleus of the thalamus for treatment of ET. DBS often reduces or eliminates the need for medications to treat ET. Proper patient selection and expertise in DBS programming are critical to ensure optimal outcomes. Recent advances in DBS include directional current steering and multisource independent constant current to program each electrode with its own power source. This chapter discusses proper patient selection, programming guidelines, and clinical pearls in DBS for ET.","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90437363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-01DOI: 10.1093/med/9780190647209.003.0038
Kyle T. Mitchell, Kristen Dodenhoff, P. Starr, J. Ostrem
DYT1 dystonia is a primary dystonia with potential for significant symptomatic improvement after bilateral deep brain stimulation (DBS) of the globus pallidus interna (GPi). GPi is the historical target of choice for this disease. This chapter presents a case of an adolescent with disabling generalized DYT1 dystonia who underwent bilateral subthalamic nucleus (STN) DBS as part of a prospective clinical trial. While limb and cervical dystonia dramatically improved with DBS, programming was limited by stimulation-induced bilateral limb dyskinesia, including in the left arm, which was previously unaffected by dystonia. After years of evolving symptoms and complex programming, bilateral interleaved settings using both a contact in motor STN and the most dorsal DBS contact in the zona incerta resulted in sustained, near-complete resolution of dystonia without side effects. This case illustrates the use of the STN as an effective DBS target for primary dystonia, although complex programming was necessary to mitigate stimulation-induced dyskinesia.
{"title":"Stimulation-Induced Dyskinesia, Interleaving Settings, and Management of Subthalamic Nucleus Deep Brain Stimulation in DYT1 Dystonia","authors":"Kyle T. Mitchell, Kristen Dodenhoff, P. Starr, J. Ostrem","doi":"10.1093/med/9780190647209.003.0038","DOIUrl":"https://doi.org/10.1093/med/9780190647209.003.0038","url":null,"abstract":"DYT1 dystonia is a primary dystonia with potential for significant symptomatic improvement after bilateral deep brain stimulation (DBS) of the globus pallidus interna (GPi). GPi is the historical target of choice for this disease. This chapter presents a case of an adolescent with disabling generalized DYT1 dystonia who underwent bilateral subthalamic nucleus (STN) DBS as part of a prospective clinical trial. While limb and cervical dystonia dramatically improved with DBS, programming was limited by stimulation-induced bilateral limb dyskinesia, including in the left arm, which was previously unaffected by dystonia. After years of evolving symptoms and complex programming, bilateral interleaved settings using both a contact in motor STN and the most dorsal DBS contact in the zona incerta resulted in sustained, near-complete resolution of dystonia without side effects. This case illustrates the use of the STN as an effective DBS target for primary dystonia, although complex programming was necessary to mitigate stimulation-induced dyskinesia.","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76904830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-01DOI: 10.1093/med/9780190647209.003.0023
Mitra Afshari, J. Ostrem, M. S. Luciano, P. Larson
This chapter discusses a case in which a “rescue” deep brain stimulation (DBS) lead was implanted to address suboptimal tremor control. The patient was a 52-year-old woman with disabling bilateral postural and action hand tremor who also had mild parkinsonian signs. An essential tremor (ET)–Parkinson disease (PD) syndrome was suspected, and subthalamic nucleus (STN) DBS was pursued. Attempts at optimizing tremor control by reprogramming were limited by the induction of brittle dyskinesia even with small amounts of stimulation. Bilateral ventral intermediate thalamus DBS leads were then implanted, and the tremors improved significantly. Troubleshooting strategies for optimizing tremor control and reducing STN DBS–induced brittle dyskinesia are discussed. The chapter reviews important learning points on DBS target selection for ET, PD, and ET-PD spectrum syndromes.
{"title":"Rescue Ventral Intermediate Thalamus Deep Brain Stimulation to Address Refractory Tremor Following Subthalamic Nucleus Deep Brain Stimulation With Brittle Dyskinesia","authors":"Mitra Afshari, J. Ostrem, M. S. Luciano, P. Larson","doi":"10.1093/med/9780190647209.003.0023","DOIUrl":"https://doi.org/10.1093/med/9780190647209.003.0023","url":null,"abstract":"This chapter discusses a case in which a “rescue” deep brain stimulation (DBS) lead was implanted to address suboptimal tremor control. The patient was a 52-year-old woman with disabling bilateral postural and action hand tremor who also had mild parkinsonian signs. An essential tremor (ET)–Parkinson disease (PD) syndrome was suspected, and subthalamic nucleus (STN) DBS was pursued. Attempts at optimizing tremor control by reprogramming were limited by the induction of brittle dyskinesia even with small amounts of stimulation. Bilateral ventral intermediate thalamus DBS leads were then implanted, and the tremors improved significantly. Troubleshooting strategies for optimizing tremor control and reducing STN DBS–induced brittle dyskinesia are discussed. The chapter reviews important learning points on DBS target selection for ET, PD, and ET-PD spectrum syndromes.","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81577051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-01DOI: 10.1093/med/9780190647209.003.0044
Shannon Y. Chiu, I. Malaty
Tardive disorders encompass phenomenologically diverse delayed-onset persistent involuntary motor symptoms associated with exposure to dopamine receptor blocking agents. Two common tardive disorders encountered in the clinical setting include tardive dyskinesia and tardive dystonia. This chapter presents a patient with severe refractory tardive dyskinesia and also tardive dystonia, manifesting as frequent and disabling retropulsion. He initially underwent bilateral globus pallidus interna (GPi) deep brain stimulation (DBS) but was found to have lead migration secondary to his severe hyperkinetic movements. He had persistent symptoms despite lead revision and ultimately required bilateral subthalamic nucleus (STN) rescue DBS implantation. The rescue procedure was synergistic with the initial GPi DBS and markedly improved his symptoms. Severe tardive dyskinesia and dystonia may respond to bilateral GPi DBS, and if necessary, rescue STN DBS can be added.
{"title":"Tardive Dystonia and Dyskinesia Responsive to Deep Brain Stimulation","authors":"Shannon Y. Chiu, I. Malaty","doi":"10.1093/med/9780190647209.003.0044","DOIUrl":"https://doi.org/10.1093/med/9780190647209.003.0044","url":null,"abstract":"Tardive disorders encompass phenomenologically diverse delayed-onset persistent involuntary motor symptoms associated with exposure to dopamine receptor blocking agents. Two common tardive disorders encountered in the clinical setting include tardive dyskinesia and tardive dystonia. This chapter presents a patient with severe refractory tardive dyskinesia and also tardive dystonia, manifesting as frequent and disabling retropulsion. He initially underwent bilateral globus pallidus interna (GPi) deep brain stimulation (DBS) but was found to have lead migration secondary to his severe hyperkinetic movements. He had persistent symptoms despite lead revision and ultimately required bilateral subthalamic nucleus (STN) rescue DBS implantation. The rescue procedure was synergistic with the initial GPi DBS and markedly improved his symptoms. Severe tardive dyskinesia and dystonia may respond to bilateral GPi DBS, and if necessary, rescue STN DBS can be added.","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84758070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-01DOI: 10.1093/med/9780190647209.003.0037
M. Siddiqui, S. Tatter
This chapter presents a case of medication-refractory primary generalized dystonia presenting with disabling symptoms of cervical dystonia and dystonic bilateral arm tremors. This case posed a challenge in the choice of the appropriate target for deep brain stimulation (DBS) because the targeting of the globus pallidus interna improves dystonia symptoms but may have a less predictable response to tremor. DBS targeting the ventral intermedius may not in many cases improve dystonia symptoms but can effectively control tremor. The authors describe a case in which they employed a systematic approach including implanting multiple leads in different DBS targets. This approach resulted in a favorable outcome for this patient in dystonia and in dystonic tremor.
{"title":"Choosing a Target for Deep Brain Stimulation in Dystonia-Associated Tremor","authors":"M. Siddiqui, S. Tatter","doi":"10.1093/med/9780190647209.003.0037","DOIUrl":"https://doi.org/10.1093/med/9780190647209.003.0037","url":null,"abstract":"This chapter presents a case of medication-refractory primary generalized dystonia presenting with disabling symptoms of cervical dystonia and dystonic bilateral arm tremors. This case posed a challenge in the choice of the appropriate target for deep brain stimulation (DBS) because the targeting of the globus pallidus interna improves dystonia symptoms but may have a less predictable response to tremor. DBS targeting the ventral intermedius may not in many cases improve dystonia symptoms but can effectively control tremor. The authors describe a case in which they employed a systematic approach including implanting multiple leads in different DBS targets. This approach resulted in a favorable outcome for this patient in dystonia and in dystonic tremor.","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83225959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-01DOI: 10.1093/med/9780190647209.003.0042
A. Shukla, Pamela Zeilman
Spinocerebellar ataxia 17 (SCA17) is a rare form of autosomal dominant cerebellar ataxia. SCA17 results from trinucleotide repeat expansions and has no effective symptomatic treatments to date. This chapter describes a case of SCA17 with dystonic symptoms that presented during adolescence. Symptoms were generalized in distribution and were accompanied with a dystonic tremor of the arms. Because many medication trials did not alleviate the patient’s symptoms, he underwent bilateral globus pallidus interna (GPi) deep brain stimulation (DBS) surgery. Several DBS programming sessions were performed. Dystonia and dystonic tremor were controlled with the settings adjusted at high pulse widths and low frequencies. Furthermore, the cyclic mode of stimulation was employed to mitigate the capsular side effects. Two years after DBS surgery, the patient presented with cerebellar ataxia that prompted an extensive workup, including genetic testing and revision of his diagnosis from generalized dystonia to a dystonia syndrome. The patient continues to endorse symptomatic benefits with DBS for dystonia and dystonic tremor 11 years after surgery, despite a diagnosis of dystonia syndrome. The current case of SCA17 cerebellar ataxia indicates that bilateral GPi DBS is a potential option for the long-term symptomatic treatment of dystonia and tremor symptoms manifesting as a part of a clinical syndrome.
{"title":"Bilateral Globus Pallidus Deep Brain Stimulation for Dystonia and Dystonic Tremor in Spinocerebellar Ataxia 17","authors":"A. Shukla, Pamela Zeilman","doi":"10.1093/med/9780190647209.003.0042","DOIUrl":"https://doi.org/10.1093/med/9780190647209.003.0042","url":null,"abstract":"Spinocerebellar ataxia 17 (SCA17) is a rare form of autosomal dominant cerebellar ataxia. SCA17 results from trinucleotide repeat expansions and has no effective symptomatic treatments to date. This chapter describes a case of SCA17 with dystonic symptoms that presented during adolescence. Symptoms were generalized in distribution and were accompanied with a dystonic tremor of the arms. Because many medication trials did not alleviate the patient’s symptoms, he underwent bilateral globus pallidus interna (GPi) deep brain stimulation (DBS) surgery. Several DBS programming sessions were performed. Dystonia and dystonic tremor were controlled with the settings adjusted at high pulse widths and low frequencies. Furthermore, the cyclic mode of stimulation was employed to mitigate the capsular side effects. Two years after DBS surgery, the patient presented with cerebellar ataxia that prompted an extensive workup, including genetic testing and revision of his diagnosis from generalized dystonia to a dystonia syndrome. The patient continues to endorse symptomatic benefits with DBS for dystonia and dystonic tremor 11 years after surgery, despite a diagnosis of dystonia syndrome. The current case of SCA17 cerebellar ataxia indicates that bilateral GPi DBS is a potential option for the long-term symptomatic treatment of dystonia and tremor symptoms manifesting as a part of a clinical syndrome.","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"169 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80629640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-06-01DOI: 10.1093/med/9780190647209.003.0029
Andi N. Sendjaja, T. Morishita, Tooru Inoue
Venous infarction is an important adverse event potentially encountered in the practice of deep brain stimulation (DBS). This adverse event is considered to result from damage to the cortical vein during surgery and is noted on postoperative day 1 or 2 owing to neurologic symptoms such as confusion and headache. The imaging findings are characterized by edema surrounding the trajectory of the DBS lead and flame-shaped hemorrhage in some cases. Venous infarction can be managed conservatively with careful observation, and the prognosis is usually benign. The neurologic condition of patients can in many cases return to baseline after days to weeks, as observed in this case. The prognostic information is valuable for reassuring afflicted patients and their families.
{"title":"Cerebral Venous Infarction After Deep Brain Stimulation Surgery","authors":"Andi N. Sendjaja, T. Morishita, Tooru Inoue","doi":"10.1093/med/9780190647209.003.0029","DOIUrl":"https://doi.org/10.1093/med/9780190647209.003.0029","url":null,"abstract":"Venous infarction is an important adverse event potentially encountered in the practice of deep brain stimulation (DBS). This adverse event is considered to result from damage to the cortical vein during surgery and is noted on postoperative day 1 or 2 owing to neurologic symptoms such as confusion and headache. The imaging findings are characterized by edema surrounding the trajectory of the DBS lead and flame-shaped hemorrhage in some cases. Venous infarction can be managed conservatively with careful observation, and the prognosis is usually benign. The neurologic condition of patients can in many cases return to baseline after days to weeks, as observed in this case. The prognostic information is valuable for reassuring afflicted patients and their families.","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88601334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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