Bilateral delayed non-ischemic enhancing brain lesions after treatment with flow-diverter

A 48-year-old woman came to our attention because of a right carotid-ophthalmic saccular aneurysm which we decided to treat with a flow-diverter implant with pipeline embolization device (Fig. 1). Acetylsalicylic acid and clopidogrel before and after endovascular treatment were administered to the patient. The procedure was successful, and there were no complications. One month after endovascular treatment, the patient presented again to out Institution, with acute left-sided weakness and numbness. She had a medical history of arterial hypertension and headache. She denied drug abuse and metal allergy. Neurological examination showed only mild left-sided hemiparesis and hypoesthesia and left Babinski sign. Her vital signs were normal as well as laboratory tests (which included biochemical analysis and microbiological cerebrospinal fluid test). Therefore, brain Magnetic Resonance Imaging (MRI) with contrast injection was performed, and it showed multiple bilateral supratentorial enhancing lesions surrounded by vasogenic edema (Fig. 1). Taken together, these findings were suggestive of bilateral delayed non-ischemic enhancing brain lesions (NICE) as granulomatous inflammatory response to a foreign body. The patient was treated with intravenous Dexamethasone, followed by tapering with oral Prednisolone. At discharge, the patient had only a subtle left-sided facial paralysis, and MRI showed normalization of the imaging findings.

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