Multifocal Brain and Spinal Cord Lesions Suggestive of CNS Demyelination after Endovascular Cerebral Aneurysm Therapy
Year: 2024
Type: article
Study design: Case Report
Abstract: Objective N/A. Background Endovascular therapy of aneurysms is rarely complicated by development of MRI enhancing brain lesions, mostly in the vascular territory used for access, suggestive of a foreign body reaction. However, there are no reports of spinal cord lesions following these procedures. We present a case of multifocal brain and spinal cord lesions identified after endovascular cerebral aneurysm therapy in one patient followed for more than 13 years with serial clinical and imaging assessments. Design/Methods N/A. Results At age 49, the patient developed left sixth nerve palsy and was subsequently found to have a left compressive optic neuropathy. Imaging revealed a left cavernous carotid artery aneurysm measuring about 2.5 cm, and a right ophthalmic artery aneurysm measuring about 5 mm. She underwent a balloon-assisted coil occlusion of the right ophthalmic artery aneurysm, followed by balloon sacrifice of the left internal carotid artery proximal to the aneurysm. Control angiography demonstrated collateral flow around the tiny balloon in the distal left MCA territory. She had no new post-procedure neurologic deficits. However, repeat MRI demonstrated small new diffusion weighted change in the territory distal to the balloon, and multiple white matter T2/FLAIR subcortical, juxtacortical and periventricular white matter post-contrast enhancement, and cervical and thoracic cord lesions. CSF showed 10.6 leukocytes (92% lymphocytes) and 1-2 bands of IgG-kappa, otherwise normal. Serial MRIs throughout 13 years of follow up revealed new enhancing lesions in the left MCA distribution. She later developed clinical events suggestive of CNS demyelination with spontaneous improvement. Conclusions We suspect that in this case, there are two processes, one related to foreign body reaction, the other related to inflammatory demyelination that may have been unmasked after the procedure. Further studies are required to elucidate the frequency and pathophysiology of enhancing brain lesions after endovascular treatment, and their potential association with multifocal CNS inflammation.
Source: Neurology
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4403206864