1513 - Unveiling the Puzzle: A Comprehensive Case Report on Deep Brain Stimulation Complications, Aphasia, and Hemiparesis

Case Diagnosis: Development of stroke like symptoms due to edema after deep brain stimulator (DBS) electrode placement.

Case Description: 65-year-old female with history of essential tremors underwent bilateral VIM DBS electrode placement and was discharged home with oral steroids and antibiotics. After one week, she presented with confusion, facial droop, right hemiparesis, and expressive aphasia concerning for stroke. Brain magnetic resonance imaging showed edema around the left electrode. She had a negative infectious workup; her edema slowly improved with dexamethasone and antibiotics. She subsequently admitted to inpatient rehabilitation on slow oral steroid taper where her aphasia and hemiparesis improved from maximum assistance on admission to minimum assistance at discharge after three weeks. However, she still had significant expressive aphasia. At six week follow up, her aphasia and hemiparesis were nearly resolved with minimal edema on imaging. Eight weeks after discharge, her DBS was activated with 90% improvement in her tremors. She progressed to independence without any assistive devices five months after her initial injury.

Discussions: While p<span style="color: black;">ostoperative peri-lead edema after DBS surgery has become a more recognized complication, this case is unique as it highlights an unusual clinical presentation of stroke-like symptoms as a result of this edema. Though the exact mechanism is unknown, symptoms were thought to be an inflammatory response to the procedure.

Conclusions: While more research is needed to identify the exact cause of this presentation, it is important to postoperatively monitor for stroke-like symptoms and consider early review of imaging in patients undergoing DBS surgery. Access to inpatient rehabilitation and prolonged steroid treatment in this case were both vital to reduce brain edema and facilitate improved functional recovery, respectively.