Tzerefos Christos, Ioannidis Ioannis, Karagiorgas Georgios P, Vlychou Mariana, Fountas Kostas N
Department of Neurosurgery, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, GRC.
Department of Radiology, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, Larissa, GRC.
Cureus. 2025 Mar 16;17(3):e80667. doi: 10.7759/cureus.80667. eCollection 2025 Mar.
Non-ischemic cerebral enhancing (NICE) lesions are a rare complication following endovascular therapy (EVT) for intracranial aneurysms, presenting as delayed-onset enhancing lesions on MRI. While their pathophysiology remains unclear, NICE lesions can pose diagnostic challenges due to their resemblance to neoplastic or infectious processes. We report a case of a 67-year-old female with incidental anterior communicating artery (ACom) and posterior inferior cerebellar artery (PICA) aneurysms treated with EVT using a flow diverter for the PICA aneurysm and stent-assisted coiling for the ACom aneurysm. Three months post procedure, a follow-up MRI revealed punctate, nodular, and annular enhancing lesions with peri-lesional edema, consistent with NICE lesions. Despite these findings, the patient remained asymptomatic, reporting only subjective fatigue. She was treated with a one-month course of glucocorticosteroids, leading to symptom resolution. Serial MRI over one year demonstrated a reduction in edema, though new lesions appeared. This case underscores the importance of long-term imaging surveillance following EVT for cerebral aneurysms, as NICE lesions may persist, regress, or evolve over time. Although the clinical course may be benign in some patients, the presence of persistent or newly emerging lesions raises concerns regarding their underlying mechanisms and potential long-term impact. Further research is needed to better understand the pathophysiology, optimize management strategies, and refine follow-up protocols for patients with NICE lesions after EVT.
非缺血性脑强化（NICE）病变是颅内动脉瘤血管内治疗（EVT）后一种罕见的并发症，在磁共振成像（MRI）上表现为延迟出现的强化病变。虽然其病理生理学尚不清楚，但由于NICE病变与肿瘤或感染性病变相似，可能会带来诊断挑战。我们报告一例67岁女性病例，该患者偶然发现前交通动脉（ACom）和小脑后下动脉（PICA）动脉瘤，对PICA动脉瘤采用血流导向装置进行EVT治疗，对ACom动脉瘤采用支架辅助弹簧圈栓塞治疗。术后三个月，随访MRI显示点状、结节状和环状强化病变，并伴有病变周围水肿，符合NICE病变表现。尽管有这些发现，但患者仍无症状，仅自述有主观疲劳感。她接受了为期一个月的糖皮质激素治疗，症状得以缓解。一年的系列MRI检查显示水肿减轻，不过出现了新的病变。该病例强调了脑动脉瘤EVT术后长期影像学监测的重要性，因为NICE病变可能会持续存在、消退或随时间演变。虽然部分患者的临床病程可能较为良性，但持续存在或新出现的病变的存在引发了对其潜在机制和长期影响的担忧。需要进一步研究以更好地理解其病理生理学，优化管理策略，并完善EVT后NICE病变患者的随访方案。
