Objective: Peri-lead edema (PLE) surrounding electrode in patients treated by deep brain stimulation (DBS) was showed on postoperative MRI in several prospective studies.

Background: PLE is commonly viewed, but usually, is completely asymptomatic, except the transient positive lesional effect. Several case reports studies reporting large hypodensity or cystic formation, usually few months after surgery, were published. In most cases these changes were observed unilaterally and led to worsening of cognition with regression after observation or after short course of steroid therapy.

Method: We report two case reports of clinically symptomatic PLE.

Results: Case report 1:
59 years old male with 13 years history of Parkinson disease indicated to bilateral subthalamic DBS developed the fourth postoperative day with still inactive stimulation the acute worsening of cognitive functions and torticollis. CT and MRI scans showed large edema surround the right electrode, future examination excluded ischemia, hemorrhage,  abscess. Also CSF examination was without signs of inflammation. Course of steroid therapy was with very good effect on torticollis and also cognitive functions within one week. CT scan performed 6 weeks later was with significant regression of edema and the DBS therapy was started with significant improvement of motor symptoms.  
Case report 2:
59 years old male with 6 years history of Parkinson disease effectively treated by bilateral subthalamic DBS for 2 months reported worsening of gait, rest-less legs syndrome, urinary incontinence and dysphonia. These symptoms were not changed by ON/OFF stimulation. MRI showed cystic formation surround both electrodes involving to the mesencephalon on the left side. Infection or ischemia was excluded. Short course of steroid therapy led to both clinical and imaging partial improvement.

Conclusion: Postoperative peri-lead aseptic reaction could be find in DBS treated patients. In symptomatic cases the short course of steroid therapy could be effective and no explantation or stimulation discontinuation should be necessary. PLE could by both unilateral and bilateral and should become days to months after surgery, also before the initiation of electric stimulation.

References: Jagid J, Madhavan K, Bregy A, Desai M, Ruiz A, Quencer R, Landy HJ. Deep brain stimulation complicated by bilateral large cystic cavitation around the leads in a patient with Parkinson’s disease. BMJ Case Rep. 2015 Oct 16;2015. pii: bcr2015211470. doi: 10.1136/bcr-2015-211470. Ryu SI, Romanelli P, Heit G. Asymptomatic transient MRI signal changes after unilateral deep brain stimulation electrode implantation for movement disorder. Stereotact Funct Neurosurg. 2004;82(2-3):65-9. Epub 2004 Mar 19. Whiting AC, Catapano JS, Walker CT, Godzik J, Lambert M, Ponce FA. Peri-Lead Edema After Deep Brain Stimulation Surgery: A Poorly Understood but Frequent Complication. World Neurosurg. 2018 Dec 28. pii: S1878-8750(18)32915-2. doi: 10.1016/j.wneu.2018.12.092. [Epub ahead of print]

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