title: Nickel-associated delayed multiple white matter lesions after stent-assisted coil embolization of intracranial unruptured aneurysm.
abstract: Metal-induced encephalopathy after stent-assisted coil embolization is extremely rare. The present report describes two patients who presented with symptomatic intracranial parenchymal edematous lesions after stent-assisted coil embolization. A 64-year-old woman underwent stent-assisted coil embolization for a left internal carotid artery aneurysm; 21 days after the procedure she presented with right hand weakness and MRI revealed multifocal white matter lesions. Another woman aged 52 years underwent stent-assisted coil embolization for right vertebral artery aneurysm; 18 days after the procedure she presented with left-sided sensory disturbance and MRI demonstrated multiple white matter lesions. Treatment in both cases resulted in improvement of these lesions after steroid pulse therapy, and the patients had no associated morbidity 4 months after the procedures. Clinicians should monitor for neurologic symptoms and postoperative delayed radiologic parenchymal edematous changes associated with the metal allergic reaction after nitinol stent-assisted coil embolization.
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Hun Soo
authors.initials: HS
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakagawa
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Yokoyama
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Wajima
authors.affiliation: Department of Radiology, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Wada
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Motoyama
authors.affiliation: Department of Radiology, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Kichikawa
authors.affiliation: Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakase
mesh_terms: D000497:Alloys / Q000009:adverse effects; D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000276:immunology*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000150:complications; D002532:Intracranial Aneurysm / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009532:Nickel / Q000276:immunology; D015607:Stents / Q000009:adverse effects*; D066127:White Matter / Q000000981:diagnostic imaging
chemical_list: D000497:Alloys; C013616:nitinol; D009532:Nickel
keywords: Aneurysm; Inflammatory Response; Stent