CASE REPORT
A Estimulação Cerebral Profunda (DBS) é um tratamento padrão para a Doença de Parkinson (DP) refratária, mas pode levar a complicações raras, como o edema adjacente ao eletrodo, que às vezes pode ser fatal. Este caso envolve um paciente idoso que desenvolveu estado mental alterado após a cirurgia de DBS, inicialmente pensado como devido à pneumonia. Uma tomografia computadorizada revelou edema do lado direito e, no dia 10, o agravamento do Parkinsonismo levou a uma ressonância magnética mostrando edema bilateral com aumento de gadolínio. Sem sinais de infeção, as derivações do DBS foram removidas, resultando na recuperação do paciente. Este caso destaca a importância do reconhecimento da EPP como diagnóstico diferencial no declínio neurológico pós-DBS. A infecção do doente pode ter desencadeado uma resposta pró-inflamatória e o agravamento do edema; e a terapêutica precoce com corticosteroides pode potencialmente manejar a doença. Em casos mais graves, pode ser necessária a remoção do eletrodo do DBS. Compreender o edema e suas complicações pode melhorar a tomada de decisões no gerenciamento de questões relacionadas ao DBS.
Deep Brain Stimulation (DBS) is a standard treatment for refractory Parkinson’s Disease (PD) but can lead to rare complications like Peri-Lead Edema (PLE), which can sometimes be life-threatening. This case involves an elderly patient who developed altered mental status after DBS surgery, initially thought to be due to pneumonia. A CT scan revealed right-sided PLE, and by day 10, worsening Parkinsonism led to an MRI showing bilateral gadolinium-enhancing PLE. With no signs of infection, the DBS leads were removed, resulting in the patient’s recovery. This case highlights the importance of recognizing PLE as a differential diagnosis in post-DBS neurological decline. The patient’s infection may have triggered a proinflammatory response, worsening PLE, and early corticosteroid therapy could potentially manage the condition. In more severe cases, DBS lead removal may be required. Understanding PLE and its complications can improve decision-making in managing DBS-related issues.
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Medical Student
Universidade do Oeste de Santa Catarina
Joaçaba, SC, Brasil
E-mail: gabrieldasilvasemione@gmail.com
Funding: nothing to disclose.
Conflicts of interest: nothing to disclose.
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1 Universidade do Oeste de Santa Catarina, Joaçaba, SC, Brazil.
2 Universidade de Piaui, Teresina, PI, Brazil.
3 Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil.
4 Centro Universitário Uninovafapi, Teresina, PI, Brazil.
5 Department of Functional Neurosurgery, Hospital Universitário da Universidade Federal do Piauí, Teresina, PI, Brazil.
Received Oct 10, 2024
Accepted Dec 19, 2024
