Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada.
Eur J Neurol. 2021 Jul;28(7):2388-2391. doi: 10.1111/ene.14844. Epub 2021 Apr 7.
In recent years, the use of coiling has gained increased popularity for the treatment of intracranial aneurysms, and stroke physicians are confronted with rare pathologies associated with this relatively new and evolving treatment method, such as embolization of pieces of the polymeric filaments from the coils and a subsequent inflammatory response. In particular, white matter enhancing lesions are a rare complication after aneurysm endovascular therapy (EVT), suggesting a foreign body reaction to shedding of hydrophilic coating from the endovascular devices into the blood stream. The description of such a case aims to raise the clinicians' awareness of the symptomatic delayed and recurring inflammatory changes that may occur after endovascular aneurysmal treatment with the use of coiling devices.
A 64-year-old woman underwent coiling of a ruptured right posterior communicating artery aneurysm. She was asymptomatic after EVT. One year later, she presented with headache, acoustic hallucinations, paresthesias and left arm weakness. Brain magnetic resonance imaging (MRI) revealed multiple enhancing white matter lesions in the right hemisphere. She was treated with pulse intravenous methylprednisolone, followed by oral prednisolone; all clinical symptoms resolved and imaging findings improved substantially. Two years after tapering the steroids, follow-up symptoms recurred and repeat brain MRI revealed new enhancing white matter lesions.
There is an increasing number of similar reports of enhancing white matter lesions after coiling of intracranial aneurysms, with the incidence estimated to be between 0.5% and 2.3% in different cohort studies. Close monitoring for the appearance of new neurologic symptoms that could suggest delayed brain reactivity should be recommended.
近年来，血管内线圈栓塞术在颅内动脉瘤治疗中的应用越来越普及，血管内介入医师也面临着与这种相对较新且不断发展的治疗方法相关的罕见病变，如线圈聚合物线碎片栓塞和随之发生的炎症反应。特别是，脑白质强化病变是颅内动脉瘤血管内治疗（EVT）后的罕见并发症，这表明亲水涂层从血管内装置脱落并进入血流后会引起异物反应。描述这种病例旨在提高临床医生对血管内栓塞治疗后可能发生的、有症状的迟发性和复发性炎症变化的认识。
一名 64 岁女性因破裂的右侧后交通动脉瘤而行线圈栓塞术。EVT 后她无症状。1 年后，她出现头痛、幻听、感觉异常和左臂无力。脑部磁共振成像（MRI）显示右侧半球有多个强化的脑白质病变。她接受了脉冲静脉甲基强的松龙治疗，随后口服泼尼松龙；所有临床症状均得到缓解，影像学发现明显改善。在类固醇减量 2 年后，随访症状再次出现，重复脑部 MRI 显示新的强化脑白质病变。
越来越多的类似报道表明颅内动脉瘤线圈栓塞术后会出现强化的脑白质病变，不同队列研究的发病率估计在 0.5%至 2.3%之间。建议密切监测可能提示迟发性脑反应的新神经症状的出现。
