Cerebral Ischemia Related to Globus Pallidus Internus Stimulation for Cervical Dystonia

Abstract

Background: Deep brain stimulation (DBS) is generally a safe and effective method to treat intractable movement disorders. However, complications of surgery have been reported, such as hemorrhage, infection and hardware failure. Objectives and Methods: We describe an unusual complication associated with DBS of the globus pallidus internus (GPi). The patient was a 34-year-old man with a 5-year history of progressive cervical dystonia that was unresponsive to medical treatment. He underwent bilateral DBS of the posteroventral GPi. After test stimulation, the patient developed left facial weakness, as well as dysarthria and hemiparesis of the left side. Magnetic resonance imaging showed a small infarct in the right posterior internal capsule. There was no misplacement of the microelectrode. Results and Conclusion: The authors present this unique case of cerebral infarction as a complication of DBS. The mechanism of ischemia is unclear. However, in this case, we had performed microstimulation with high amplitude in order to determine the adverse effects. This magnitude of electrical stimulation may have led to small-vessel vasospasm, which may have induced ischemia. Although ischemia after DBS surgery is seldom reported, cerebral ischemia may be a surgical complication after DBS implantation.

Early internal capsule infarction following globus pallidus internus lesioning for cervical dystonia

“…Most of subcortical ischemia are seen in patients who undergo DBS, mostly during micro-electrode recording (MER). Kang et al reported an ischemic stroke of the posterior limb of the internal capsule during GPi DBS procedure in a 34- year-old patient with cervical dystonia [12] . Downes et al reported the incidence of ischemic stroke during GPi DBS was 2.14% per lead [13] .…”

“…Lim et al showed that there was a significantly higher incidence of infarction in patients with preexisting vascular disease compared to that in patients who only had risk factors for vascular disease [11] . Kang et al said that one possible mechanism of ischemic stroke during movement disorder surgery is vasospasm induced by electrical stimulation [12] . Novak et al believe that the area of edema may compress the small penetrating arteries, thus resulting in ischemia.…”

Deep Brain Stimulation: The Perspective of Brain Connectivity

“…There is no general consensus regarding whether the MER is related to ICH [101,102]. Cerebral infarction occurs; however, it is extremely rare [103][104][105][106]. Other complications associated with permanent neurological deficits are postoperative delirium, seizures, and other complications in the patient's general state.…”