Objective: To report the case of a patient that developed a post-operative asymptomatic, transitory, non-infection hypodense lesion around DBS lead, literature review and discussion of its management.

Background: There are few published reports of transient, non-infectious, hypodense lesions surrounding the DBS electrode. Its etiology remains debatable in most clinical reports, and may have a wide spectrum of manifestations, with some passing unnoticed and other being severely symptomatic with need to invasive interventions.

Methods: A 47 years-old male patient, with young onset Parkinson’s disease, was submitted to bilateral STN-DBS surgery without acute complications and the DBS system were programed 1 week after system implantation with a good clinical response (MDS-UPDRS-III off medication/off stimulation: 57; off medication/on stimulation: 32; On medication/on stimulation: 8). One month later a hypodense lesion in superior-frontal region, around right DBS electrode, was noticed in routine brain CT [Figure 1]. This lesion did not showed enhancement after contrast administration. The patient at this moment presented no focal neurological symptoms, no worsening of Parkinsonian symptoms or infectious symptoms, namely suggestive of central nervous system infection.

Results: Control brain CT, 2 days after being admitted were similar and the patient remained asymptomatic, and did not presented changes in blood inflammatory markers. The patient was discharged at that moment and repeated brain CT after 3 weeks. In that exam the lesion was less hypodense and has smaller dimensions comparatively to the first exam [Figure 2]. The patient remained clinically asymptomatic with no worsening of parkinsonian symptoms.

Conclusions: Despite of the benign course of the lesion described in this case report, the pathophysiology of this post-operative lesions remains unknown. In literature, the impact of these lesions is highly variable with some patient requiring invasive measures and sometimes with neurological sequelae.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/asymptomatic-and-transitory-postoperative-hypodense-lesion-around-deep-brain-stimulation-electrode/