Two cases of ischemia associated with subthalamic nucleus stimulator implantation for advanced Parkinson's disease

• Published in: Movement disorders Vol. 21; no. 9; pp. 1477 - 1483
• Main Authors: Novak, Kevin E., Nenonene, Emmanuel K., Bernstein, Lawrence P., Vergenz, Sandra, Medalle, Gina, Prager, Jordan M., Eller, Theodore W., Cozzens, Jeffrey W., Rezak, Michael
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.09.2006; Wiley
• Subjects: Aged; Biological and medical sciences; Caudate Nucleus - blood supply; Cerebral Infarction - diagnosis; Cerebral Infarction - etiology; Cerebral Infarction - physiopathology; complications; deep brain stimulation; Deep Brain Stimulation - adverse effects; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Diffusion Magnetic Resonance Imaging; Dominance, Cerebral - physiology; Electrodes, Implanted - adverse effects; Female; Humans; Image Processing, Computer-Assisted; ischemia; Male; Medical sciences; microelectrode recording; Microelectrodes; Neurology; Neurons - physiology; Parkinson Disease - physiopathology; Parkinson Disease - rehabilitation; Parkinson's disease; Risk Factors; Stereotaxic Techniques; subthalamic nucleus; Subthalamic Nucleus - physiopathology; Surgery, Computer-Assisted; Thalamic Diseases - diagnosis; Thalamic Diseases - etiology; Thalamic Diseases - physiopathology; Tomography, X-Ray Computed; Vascular diseases and vascular malformations of the nervous system; Nervous system diseases; microelectrode recording; Parkinson's disease; complications; Deep brain stimulation; Central nervous system; Parkinson disease; Cardiovascular disease; Stimulator; Cerebral disorder; Ischemia; Central nervous system disease; Microelectrode; Complication; Advanced stage; Degenerative disease; Subthalamic nucleus; Extrapyramidal syndrome
• ISSN: 0885-3185; 1531-8257
• DOI: 10.1002/mds.20947

Deep brain stimulation is generally a safe and effective method of alleviating motor impairment in advanced‐stage Parkinson's disease patients. However, adverse events of surgery have been noted, such as hemorrhage, infection, seizures, and device failure. In this report, we describe 2 cases of the unusual adverse event of ischemia associated with subthalamic nucleus stimulator implantation. We present the intraoperative neurological symptoms, microelectrode recording data, imaging findings, and other correlated events. In the first case, the clinical effects of ischemia were evident intraoperatively and coincided with silence during microelectrode recording from the ischemic region. In the second case, the timing of the ischemic event could not be determined precisely but also was associated with a difficult mapping. Subcortical ischemia may be an underrecognized event that confounds neurophysiological mapping of deep brain structures and affects clinical outcomes. © 2006 Movement Disorder Society