We report two cases of delayed leukoencephalopathy (DLE) secondary to aneurysmal intracranial stenting and a middle ear prosthesis, both made of a nickel-titanium alloy (nitinol).

A 36-year-old woman with a history of ankylosing spondylitis presented with headache and visual distortion. She was found to have an intracranial aneurysm that was repaired with the Neuroform Atlas Stent System. Five weeks later, she acutely developed a fluctuating right sensorimotor deficit. Magnetic resonance imaging (MRI) of the brain showed small regions of T2 hyperintensity with stippled enhancement in the right frontal lobe along the superior frontal sulcus and the white matter of the left parietal and occipital lobes. Another 72-year-old woman with a history of otosclerosis, status post-surgery with eclipse piston prosthesis, presented with right trigeminal neuralgia. A brain MRI showed a right paraclinoid meningioma and three upper cervical cord lesions on sagittal slices. She received radiotherapy with improvement. Seven weeks later, she developed hypersomnolence, vomiting, diplopia, and ataxia. Brain MRI demonstrated an interval appearance of multifocal and bilateral ring-enhancing lesions in the cerebellum, pons, and the right midbrain. Both patients had extensive and unremarkable serum, CSF, vascular and spine imaging, and malignancy workup. A manufacturer review of both devices revealed that they were made of nitinol.