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Two cases of ischemia associated with subthalamic nucleus stimulator implantation for advanced Parkinson's disease

Authors

  • Kevin E. Novak PhD,

    Corresponding author
    1. Department of Neurology, at Evanston Northwestern Healthcare, Evanston, Illinois, USA
    2. Department of Neurology, at Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
    • Evanston Northwestern Healthcare, Department of Neurology, 2650 Ridge Avenue, Searle 4995E, Evanston, IL 60201
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  • Emmanuel K. Nenonene DSci, PhD,

    1. Department of Neurology, at Evanston Northwestern Healthcare, Evanston, Illinois, USA
    2. Department of Neurology, at Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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  • Lawrence P. Bernstein MD,

    1. Department of Neurology, at Evanston Northwestern Healthcare, Evanston, Illinois, USA
    2. Department of Neurology, at Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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  • Sandra Vergenz RN,

    1. Department of Neurology, at Evanston Northwestern Healthcare, Evanston, Illinois, USA
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  • Gina Medalle RN,

    1. Department of Neurology, at Evanston Northwestern Healthcare, Evanston, Illinois, USA
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  • Jordan M. Prager MD,

    1. Department of Radiology, at Evanston Northwestern Healthcare, Evanston, IL, USA
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  • Theodore W. Eller MD,

    1. Department of Neurosurgery, Rockford Memorial Hospital, Rockford, Illinois, USA
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  • Jeffrey W. Cozzens MD,

    1. Department of Neurosurgery, at Evanston Northwestern Healthcare, Evanston, Illinois, USA
    2. Department of Neurosurgery, at Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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  • Michael Rezak MD, PhD

    1. Department of Neurology, at Evanston Northwestern Healthcare, Evanston, Illinois, USA
    2. Department of Neurology, at Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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Abstract

Deep brain stimulation is generally a safe and effective method of alleviating motor impairment in advanced-stage Parkinson's disease patients. However, adverse events of surgery have been noted, such as hemorrhage, infection, seizures, and device failure. In this report, we describe 2 cases of the unusual adverse event of ischemia associated with subthalamic nucleus stimulator implantation. We present the intraoperative neurological symptoms, microelectrode recording data, imaging findings, and other correlated events. In the first case, the clinical effects of ischemia were evident intraoperatively and coincided with silence during microelectrode recording from the ischemic region. In the second case, the timing of the ischemic event could not be determined precisely but also was associated with a difficult mapping. Subcortical ischemia may be an underrecognized event that confounds neurophysiological mapping of deep brain structures and affects clinical outcomes. © 2006 Movement Disorder Society

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