Asymptomatic deep venous thrombosis after deep brain stimulation for Parkinson disease.
OBJECTIVE
Patients with advanced Parkinson disease (PD) are at increased risk for asymptomatic leg deep venous thrombosis (DVT) because of severe motor fluctuations. Protracted immobility in the absence of antiparkinsonian therapy during stereotactic surgery may further increase the risk for venous thrombosis. Our aim was to determine the incidence of asymptomatic DVT of leg veins in PD patients undergoing subthalamic nucleus deep brain stimulation (STN-DBS).


METHODS
41 consecutive PD patients undergoing stereotactic surgery for STN-DBS were investigated by ultrasound compression sonography of leg veins and D-dimer measurement in the week preceding surgery. After surgery, D-dimer measurements were repeated and when the value exceeded the normal range, ultrasound compression sonography was repeated to confirm or exclude DVT.


RESULTS
Doppler ultrasonographic examinations demonstrated that 2 patients (4.9%) developed asymptomatic DVT shortly after surgery (8.5 days) despite the fact that none of the 41 patients submitted to STN-DBS had DVT before surgery and that a specific prophylaxis was applied during surgery.


CONCLUSIONS
Our data show that advanced PD patients are at risk for developing asymptomatic leg DVT following stereotactic surgery performed for STN-DBS. A strict clinical monitoring in the perioperative period is advisable in order to ensure early detection of DVT and prevent further thrombo-embolic complications.
Department of Neuroscience, University of Torino, Torino, Italy. maurizio.zibetti @ gmail.com
Maurizio
M
Zibetti
Mara
M
Rosso
Annina
A
Cinquepalmi
Michele
M
Lanotte
Serena
S
Angrisano
Claudio
C
Rabbia
Susanna
S
Valpreda
Leonardo
L
Lopiano
D000368:Aged; D046690:Deep Brain Stimulation / Q000009:adverse effects*; D004567:Electrodes, Implanted / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology*; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*