Objective: Intraparenchymal cyst formation after Deep Brain Stimulation (DBS) surgery is a rare complication. There are only 8 cases reported in the literature. We report a patient who developed hemiparesis after DBS placement due to intraparenchymal cyst formation.

Background: NA.

Methods: NA.

Results: Case report. A 68 year old RH female with 5 year history of tremor positive Parkinson’s disease H&Y stage 2.5 complicated by both frequent wearing off as well as peak dose dyskinesias underwent bilateral staged DBS placement. Prior to surgery she was on carbidopa/levodopa (25/100) 2 tabs q3 hours, Sinemet CR (50/200) 1 tab hs and Requip 3mg TID. She underwent uncomplicated Right Subthalamic Nucleus (STN) DBS in late October 2016 and Left STN DBS placement in mid December 2016. Programming of bilateral STN DBS began in December 2016. She did well after programming with amelioration of tremor and dyskinesia. Meds were reduced by more than 50%. However, a few days after programming (10 weeks post 1st DBS implant), she developed dysphagia, dysarthria, falls and left sided paresthesias which did not improve when stimulator was switched off. Neurological exam revealed a left hemibody upper motor neuron weakness. An urgent MRI brain showed R DBS electrode with fluid collection surrounding the tip as well as mild edema and local mass effect. Due to persistence of both her symptoms and cyst on repeat imaging, her R STN lead was removed a month after the onset of her symptoms (14 weeks post 1st DBS implant). Over several months, she showed resolution of her hemiparesis and reduction in the size of her cyst. Despite her left hemiparesis completely resolving, her parkinsonism has not recurred after 1 year.

Conclusions: We report a case of intraparenchymal cyst formation 10 weeks after DBS placement resulting in a hemiparesis. Our patient showed reversal of her hemiparesis with preserved benefit for parkinsonism after removal of the affected lead. Intraparenchymal cyst formation may present as a delayed post-op complication. It is important to recognize that intraparenchymal cyst formation post DBS is a rare but serious complication.

References: 1. Ramirez-Zamora A. et al. Intraparenchymal cyst development after deep brain stimulator placement. Stereotact Funct Neurosurg 2013;91:338–341. 2. Vibhash D. Sharma et al. Cystic Lesions as a Rare Complication of Deep Brain Stimulation. Movement Disorders Clinical Practice 2016; Volume 3, Issue 1:87–90.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/intraparenchymal-cyst-formation-a-rare-complication-of-deep-brain-stimulation/