2018 Volume 27 Issue 10 Pages 773-780
The patient is a 57-year-old female, with a past history of ruptured aneurysm of left MCA bifurcation, treated with coil embolization. One year follow up angiography showed partial recanalization of the aneurysm. She underwent stent-assisted coiling under general anesthesia. Head CT performed on day 4 postoperatively revealed small high density area of left insula. Following MRI showed parenchymal micro-bleeding. Consecutive CT showed no sign of hematoma expansion or re-bleeding. Since the patient was asymptomatic, she was discharged. One month after the procedure, she presented with slight disorientation and weakness of the right hand. Head CT showed diffuse brain edema. Delayed sequence contrast CT revealed white matter change with multi-focal ring enhancement. The diffuse multifocal enhanced lesions were suspected to be the cause of the edema. Head MRI was taken to rule out the possibility of brain infarction. Diffusion weighted image excluded the possibility of brain infarction caused by the stent occlusion. Hydrophilic polymer-induced multiple foreign body granulomas were suspected. The patient was treated with steroids and fully recovered. Since its natural history is still unknown, foreign body granuloma might be underestimated as a complication of endovascular surgery. Micro-bleeding caused by foreign body granuloma in the early stage after surgery is rare, and could be the early sign of foreign body granuloma. We suggest that the delayed sequence contrast CT might be helpful for early detection and diagnosis of foreign body granuloma.
