2025 American Academy of Neurology Abstract Website

Objective:

To highlight a rare occurrence of delayed venous hemorrhage following deep brain stimulation (DBS) probe placement despite initial negative neuroimaging.

Background:

Cerebral hemorrhage is a significant complication of DBS procedures, typically presenting either asymptomatically on post operational imaging or with detectable symptoms soon after surgery. This report details a case involving a 72-year-old female who underwent DBS probe insertion and later experienced generalized cognitive decline followed by a seizure 27-hours post-operation despite normal CT imaging at 6- and 27-hours post-operation.

Design/Methods:

N/A

Results:

A 72-year-old women with a 19-year history of parkinsonian tremor underwent left subthalamic electrode placement. Post-operative CT imaging and initial clinical assessments were stable. However, during the later half of the first day post-surgery, she began to exhibit a decline in alertness and higher order thinking. The patient presented to the emergency department for further evaluation. A repeat scan 27 hours post-operation in the emergency department again showed no acute issues. However soon after imaging, the patient experienced a tonic-clonic seizure that required intravenous lorazepam to abort. CT imaging conducted 58 hours post-operation revealed an irregular multinodular subcortical hemorrhage with associated cerebral edema, indicative of a venous infarction. The patient responded well to standard medical management including blood pressure control, seizure management, and repeat imaging to confirm hemostasis. The patient was transferred to inpatient rehabilitation by day 9 with no focal deficits.

Conclusions:

Subcortical hemorrhages following DBS placement are commonly detected soon after the procedure by either standard post-procedure imaging or due to focal clinical changes warranting prompt investigation. However, rare cases can initially present with vague symptoms and negative neuroimaging for multiple days if secondary to venous infarctions. Fortunately, once identified these hemorrhages can usually be managed effectively using standard medical management and rarely require surgical intervention or result in long-term disability.