Abstract Details

Title Severe Allergic Reaction with Cerebral Edema Post Flow-Diverter Device Placement for Cerebral Aneurysm

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 13-010

Objective To report a case of a severe allergic reaction to the nickel and cobalt components of the metal alloy in Pipeline Embolization Device (PED), which led to severe cerebral edema and focal motor seizures.

Background Flow-diverting devices (FDD) are frequently used in the endovascular treatment of intracranial aneurysms. Thromboembolism is the most common complication from this procedure leading to ischemic stroke or intracranial hemorrhage. Review of literature revealed rare complications of FDD leading to polymer embolization and cerebral edema. However, not much is known regarding the risk of a severe allergic reaction from the metallic components of FDD.

Design/Methods Case presentation and review of literature

Results 54-year-old right-handed woman presented to the emergency department with headache and acute-onset right sided focal-motor seizures with secondary generalization. She had a recent FDD placement (PED) in the supraclinoid segment of the left internal carotid artery (ICA) for aneurysm embolization four weeks prior. Non-contrast CT head showed a hypodensity in the left hemisphere. CT angiogram of the head and neck showed a secured left ICA aneurysm with FDD in place. She was loaded with levetiracetam 2g IV followed by a maintenance dose of levetiracetam 750mg twice daily. MRI brain with and without contrast showed vasogenic edema in the subcortical regions of the left frontal, parietal, and temporal lobes. She was treated with IV steroids and antihistamine with reportedly significant clinical improvement in the two-month follow up visit. Repeat MRI Brain two months after the initial one showed a substantial resolution of the cerebral edema. Skin patch testing demonstrated severe allergy to nickel and moderate-to-severe allergy to cobalt, which are known structural components of the FDDs.

Conclusions

We recommend a routine pre-screening questionnaire for metal allergies in patients who will undergo FDD treatment.

Authors/Disclosures
Avi Landman, MD PRESENTER	Dr. Landman has nothing to disclose.
Jorge L. Morales, MD	Dr. Morales has nothing to disclose.
Ankur Garg, MD (Orlando Neurosurgery)	Dr. Garg has nothing to disclose.
Muhammad-Atif Zubairi, MD (HCA Florida Osceola Hospital)	Dr. Zubairi has nothing to disclose.

��ɫ��

��ɫ��