Abnormal White Matter Changes After Cerebral Aneurysm Treatment with Polyglycolic-Polylactic Acid Coils
Abnormal White Matter Changes After Cerebral Aneurysm Treatment with Polyglycolic-Polylactic Acid Coils
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DOI：
10.1016/j.wneu.2010.03.026
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发表时间：
2010-12-01
影响因子：
2
通讯作者：
Pandey, Aditya
中科院分区：
文献类型：
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作者：
Skolarus, Lesli E.;Gemmete, Joseph J.;Pandey, Aditya
背景：聚乙醇-聚乳酸（PGLA）线圈可诱导脑动脉瘤内的炎症，从而减少动脉瘤复发。我们报告了2例用PGLA线圈缠绕动脉瘤后出现轻度症状和广泛的磁共振成像（MRI）白质改变的患者。方法：第一位患者是一名46岁的女性，她对偶然发现的6.8 x 6.8 x 7.0 mm的基底顶动脉瘤进行了卷取。动脉瘤缠绕约1个月后，患者出现闪烁性暗斑，MRI显示双侧脑白质改变伴点状强化。第二例患者为56岁女性，在支架辅助卷绕术治疗破裂的12 × 8毫米基底动脉瘤1个月后出现感觉异常和步态不稳。脑部核磁共振成像也显示双侧白质改变，点状增强，脑桥扩散受限。结果：两例患者均采用PGLA线圈进行动脉瘤缠绕。广泛的临床评估没有发现具体的病因。患者的症状和MRI异常在几周内自然改善。结论：结论：在对其他疾病原因进行广泛评估后，我们假设患者的症状和MRI表现（并非全部在卷曲血管提供的区域内）是由于与PGLA线圈相关的过度炎症反应所致。这些病例强调了在动脉瘤缠绕后亚急性期对神经系统疾病的临床怀疑的重要性。我们建议对这些患者进行低阈值的神经影像学检查。
BACKGROUND: Polyglycolic-polylactic acid (PGLA) coils induce inflammation within a cerebral aneurysm, which in turn is hypothesized to decrease aneurysm recurrence. We present 2 patients, who after aneurysm coiling with PGLA coils, developed mild symptoms and extensive magnetic resonance imaging (MRI) white matter changes.METHODS: The first patient was a 46-year-old woman who underwent coiling of a 6.8 x 6.8 x 7.0-mm incidentally discovered basilar apex aneurysm. Approximately 1 month after her aneurysm coiling, she developed scintillating scotoma, and an MRI of her brain revealed bilateral white matter changes with punctate enhancement. The second patient, a 56-year-old woman, developed paresthesias and gait instability 1 month after retreatment of a ruptured 12 x 8-mm basilar tip aneurysm with stent assisted coiling. MRI of the brain also revealed bilateral white matter changes with punctate enhancement as well as an area of restricted diffusion in her pons.RESULTS: Both patients underwent aneurysm coiling with PGLA coils. An extensive clinical evaluation revealed no specific etiology. The patients' symptoms and MRI abnormalities improved spontaneously over a period of weeks.CONCLUSIONS: Conclusions: After extensive evaluation for alternate causes of disease, we hypothesize that the patients' symptoms and MRI findings, which were not all within the territory supplied by the coiled vessel, were due to an overexuberant inflammatory response related to the PGLA coils. These cases highlight the importance of heightened clinical suspicion of neurologic complaints in the subacute period after aneurysm coiling. We recommend a low threshold for neuroimaging of these patients.