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Abstract Details

Diffuse Intracranial Necrotizing Granulomas in a Female on Secukinumab After a Right Pericallosal Aneurysm Stent-assisted Coil
General Neurology
P3 - Poster Session 3 (11:45 AM-12:45 PM)
2-007

To present a case of diffuse intracranial necrotizing granulomas after a right pericallosal cerebral aneurysm stent-assisted coil.  

Intracranial coils are commonly used to treat unruptured cerebral aneurysms. Microcatheters and coils have polymer-based coatings which enhance maneuverability and decrease endothelial trauma. However, rare cases of iatrogenic embolization of the polymer gel causing foreign body granulomatous reactions have been reported.
NA
A 56-year-old female with a history of psoriasis on secukinumab and a right pericallosal aneurysm with a stent-assisted coil presented with a severe headache two weeks after surgery, followed by left hand and face numbness two weeks later. On physical examination, she reported decreased sensation in her left face and hand but had an otherwise normal neurological examination. Brain magnetic resonance imaging (MRI) showed diffuse bilateral parenchymal and leptomeningeal nodular enhancement with associated vasogenic edema, most notable in the right cerebral hemisphere, and mass effect on the right lateral ventricle with mild leftward midline shift. Lumbar puncture showed a protein of 127.4 mg/dL, glucose of 64 mg/dL, and nucleated count of 26/uL (84% lymphocytes, 10% neutrophils, and red blood cell count 685/uL). Flow cytometry and cytology were negative for malignancy. Herpes simplex virus and John Cunningham virus polymerase chain reaction were negative. Continuous electroencephalogram did not show seizures. Brain biopsy showed necrotizing granulomatous and perivascular inflammation with negative infectious/microbiology panels. She was treated with a course of intravenous methylprednisolone followed by an extended prednisone taper resulting in clinical and radiographic improvement.

Granulomatous inflammation after endovascular interventions using hydrophilic polymer-coated wires is a rare and under-recognized complication. Given its responsiveness to steroid treatment, this complication should be considered in patients with new neurological findings after endovascular interventions.
Authors/Disclosures
Kyle Kaneko, DO (Barrow Neurological Institute)
PRESENTER 		Dr. Kaneko has nothing to disclose.
Rachna Khanna, DO Dr. Khanna has nothing to disclose.
Giovanni R. Malaty, MD Dr. Malaty has nothing to disclose.
Michael V. Robers, MD (Barrow Neurological Institute) Dr. Robers has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Robers has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG therapeutics. Dr. Robers has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi. Dr. Robers has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for TG Therapeutics. The institution of Dr. Robers has received research support from Bristol Myers Squibb Foundation.