Headache and MRI Changes after Endovascular Treatment of a Cerebral Aneurysm

Abstract

Background. The main complications after endovascular therapy of intracranial aneurysms are aneurysm rupture and thromboembolic events. Yet, the widespread use of magnetic resonance imaging (MRI) in follow-up of these patients also demonstrates other, rarely known complications such as aseptic meningitis and foreign body reaction. Case Presentation. A small aneurysm in the right posterior communicating artery was treated with endovascular therapy in a 65 year old woman. Two weeks after successful interventional treatment, the patient developed a headache. On MRI performed five months after intervention, vasogenic edema was seen in the vascular territory of the right internal carotid artery. The edema and the symptoms diminished without specific treatment within a year. Interpretation. The clinical and radiological presentation of this case are suggestive of a foreign body reaction, a treatable condition that radiologists and clinicians should be aware of.

Delayed Leukoencephalopathy and Foreign Body Reaction After Endovascular Treatment in Patients With Intracranial Aneurysms and Aneurysmal Subarachnoid Hemorrhage—A Systematic Review of the Literature

“…Given the benign clinical course in the majority of cases, to treat or not to treat remains the main question. Only 5 out of 17 studies (5/18 including our case) have reported cases not being treated ( 21 , 30 , 36 , 38 , 39 ). This might be due to lack of symptoms in the corresponding patients.…”

“…After exclusion of duplicates [1 article present in both search results ( 21 ); 13 articles] and adding cross-referenced articles that were not found by primary MEDLINE/Pubmed search (4 articles), a total of 17 articles remained for further review and data analysis ( 21 – 24 , 28 – 40 ). In detail, 15 studies included intracranial aneurysms, 9 of which analyzed (at least in part) ruptured aneurysm cases ( 21 , 24 , 29 , 30 , 32 , 35 – 37 , 39 ) ( Figure 1 ). Two of the articles included a heterogenic cohort of various endovascularly treated pathologies in addition to intracranial aneurysms ( 33 , 37 ).…”