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  • Acute ischemic Stroke During DBS Surgery of Globus Pallidus Internus: A Rare Complication of Deep Brain Stimulation: Report of 5 Cases

    Final Number:
    1560

    Authors:
    Angela Elizabeth Downes MD; Nader Pouratian MD, PhD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is a clinically proven efficacious treatment for patients with Parkinson’s disease (PD) who developped complications with medical therapy. Several studies have documented complications associated with DBS surgery, most commonly infection and hemorrhage; however, reports of acute cerebral ischemic infarctions during GPi DBS implantation surgery are rare.

    Methods: We present a series of five patients who underwent bilateral GPi DBS lead placement for PD and suffered from clinically significant ischemic strokes during surgery. All surgeries were performed with single tracks for both microelectrode recording and macroelectrode

    Results: All five patients developed acute onset of lethargy, dysarthria, contralateral facial and hemibody weakness at different times during DBS surgery. Patients with tremor-dominant PD also experienced abrupt resolution of contralateral tremor. Immediate postoperative CTs performed in all cases were negative for hemorrhage. MRI was performed in one patient after generator placement, and revealed ischemia in the posterior limb of the internal capsule and lateral putamen.

    Conclusions: Focal acute ischemic stroke is a rare complication of DBS surgery. The authors present a case series of 5 patients with symptomatic cerebral ischemia occurring during DBS placement. The mechanism is unclear, as the time of symptom onset was different in each patient. One explanation could be electrical stimulation causing vasospasm of the lenticulostriate perforating arteries.

    Patient Care: awareness

    Learning Objectives: By the conclusion of this session, participants should be able to describe common complications of dbs

    References:

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