Neurological Changes with Abnormal Brain Reactivity Following Coiling of Cerebral Aneurysm. Possible Reactivity to Endovascular Devices and Material?

Abstract

A 65-year-old woman presented with headaches and
underwent coiling of an unruptured posterior communicating artery aneurysm. A few days later, she developed
left-sided weakness. MRI revealed enhancing white matter lesions in the ipsilateral hemisphere. The patient
underwent extensive work-up and was treated with a
prolonged course of immunosuppression.
Thirty months postcoiling, the patient had resolution of
all clinical symptoms. Imaging revealed improvement in
the white matter changes. Six months after tapering the
immunosuppressants, follow-up MRI showed interval
development of new white matter lesions. The patient
was restarted on immunosuppression and was clinically
stable at 47 months postcoiling.
We present a case with abnormal brain reactivity following elective coiling of an aneurysm, with a review of
clinical outcome at 47 months. We discuss the radiological findings, along with management of this phenomenon, and review the literature.