Delayed leukoencephalopathy and subsequent small ischemia after endovascular treatment in a patient with cerebral aneurysm

Abstract

A 51-year-old woman underwent stent-assisted coiling for an unruptured left intracranial carotid artery aneurysm. She developed headache and abdominal pain 3 months after the treatment, and an interview for these unidentified complaints revealed her history of metallic allergy. MRI showed vasogenic focal edema and small enhancing lesions in the ipsilateral cerebral white matter. Although not confirmed with biopsy, clinical course and imaging evidence suggested that she probably developed delayed leukoencephalopathy that is reported as a rare complication after coiling. Oral prednisolone (30 mg tapering to 0 mg over 5 weeks) was successful; however, small ischemic lesions were observed in the edematous core. We reviewed the pathophysiological mechanism of this delayed complication, and we enlightened the noteworthy phenomenon after endovascular treatment.