Two cases of ischemia associated with subthalamic nucleus stimulator implantation for advanced Parkinson's disease.
Deep brain stimulation is generally a safe and effective method of alleviating motor impairment in advanced-stage Parkinson's disease patients. However, adverse events of surgery have been noted, such as hemorrhage, infection, seizures, and device failure. In this report, we describe 2 cases of the unusual adverse event of ischemia associated with subthalamic nucleus stimulator implantation. We present the intraoperative neurological symptoms, microelectrode recording data, imaging findings, and other correlated events. In the first case, the clinical effects of ischemia were evident intraoperatively and coincided with silence during microelectrode recording from the ischemic region. In the second case, the timing of the ischemic event could not be determined precisely but also was associated with a difficult mapping. Subcortical ischemia may be an underrecognized event that confounds neurophysiological mapping of deep brain structures and affects clinical outcomes.
Novak
Kevin E
KE
Department of Neurology, at Evanston Northwestern Healthcare, Evanston, Illinois, USA.
Nenonene
Emmanuel K
EK
Bernstein
Lawrence P
LP
Vergenz
Sandra
S
Medalle
Gina
G
Prager
Jordan M
JM
Eller
Theodore W
TW
Cozzens
Jeffrey W
JW
Rezak
Michael
M
D000368:Aged; D002421:Caudate Nucleus / Q000098:blood supply; D002544:Cerebral Infarction / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D038524:Diffusion Magnetic Resonance Imaging; D004292:Dominance, Cerebral / Q000502:physiology; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008839:Microelectrodes; D009474:Neurons / Q000502:physiology; D010300:Parkinson Disease / Q000503:physiopathology / Q000534:rehabilitation*; D012307:Risk Factors; D013238:Stereotaxic Techniques; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D025321:Surgery, Computer-Assisted; D013786:Thalamic Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D014057:Tomography, X-Ray Computed