Figure 1
(Case 1) Initial MRI showing ill-defined T1 hyperintensities in the right basal ganglia (A) without changes in the internal capsule and minimal contrast enhancement with gadolinium without surrounding edema (B). Diffusion weighted sequences showing decreased signal in the right basal ganglia with no restriction (C & D). Fluid attenuated inversion recovery (FLAIR) images show isointense signal (E) with hypointenisty on T2 images (F) in the basal ganglia. There was no significant gradient echo (GRE) susceptibility to suggest hemorrhage (G).
Figure 2
(Case 2) Initial MRI brain images showing T1 hyperintensity in the right basal ganglia (A) with minimal contrast enhancement (B). In the upper lateral aspects of the right caudate, there was a rim of T2 hypointenisty surrounding a central core of T2 hyperintensity (C). The rim had mixed GRE susceptibility (D). There was no evidence of any edema surrounding the right basal ganglia lesion.
Figure 3
(Case 3) MRI brain showing T2 hyperintensity (A) and FLAIR changes (B) seen around the right electrode compared to his prior imaging with associated restricted diffusion (images not available). The signal abnormalities predominantly involved the right thalamus and basal ganglia.
Table 1
Summary of cases.
| CASES | AGE (YRS)/GENDER | PRESENTATION | ETIOLOGY | DURATION | TARGET | OUTCOME | DBS PARAMETERS | COMMENTS |
|---|---|---|---|---|---|---|---|---|
| Hasegawa et al., 2009 | 56/M | Left HB | Right subthalamic region hemorrhage | 3 years | Right GPi | Resolved at 6 months | C+1–, 4.5 V, 60 μs, 130 Hz | Patient also had mild dystonic posturing of left wrist |
| Capelle et al., 2011 | 52/M | Right HC-HB | Post craniopharyngioma resection | 3 years | Right GPi + Right VIM | Resolved at initial programming, adjusted at 19 months | 3+0–, 0.8 V, 210 μs, 130 Hz | Left VIM-DBS used for long-term stimulation |
| Omaya et al., 2014 | 44/M | Left HB | Stroke | 1 month | Right GPi | Resolved at 1 week | C+ 1–, 3.3 V, 90 μs, 135 Hz | Stroke adjacent to R electrode for PD, STN electrode remained |
| Xie et al., 2014 | 22/M | Left HC | DVA/hemorrhage | 4 years | Right GPi | Well suppressed at 10 months | C+1–, 3.6 V, 120 μs, 60 Hz | Microhemorrhage from vascular malformation in right STN |
| Pabaney et al., 2015 | 54/M | Right HB | Peri-electrode edema around STN lead | 2 weeks | Left GPi | Substantially reduced | C+1–, 2.0 V, 90 μs, 160 Hz | STN-DBS for PD with left STN hematoma after fall. |
| Son et al., 2017 | 46/F | Left HC-HB | NKHG | 6 months | Right GPi | Resolved at 16 months | 2+1–, 3.5 mA, 110–130 μs, 130 Hz | Minimal left calf and foot chorea at 16 weeks. |
| Ramirez et al., 2018 | 53/F | Left HB | Stroke | ~ 20 years | Right GPi | Near complete resolution at 6 months | C+0–, 3.0 V, 90 μs, 130 Hz | Peripartum infarction in her 30s |
| Ganapa et al., 2019 | 46/M | HB | Stroke | Not reported | Right GPi | Improved, lost to follow up | Not reported | |
| Case 1 | 68/F | Left HC | NKGH | 5 years | Right GPi | Moderate to marked improvement at 1 year | C+ 1–,3.5 V, 90 μs, 130 Hz | Mild fluctuations in symptoms |
| Case 2 | 71/M | Left HC | Infarct/NKHG | 5 months | Right GPi | Marked improvement at 4 months | C+1–, 2.4 V, 60 μs, 130 Hz | Lost to follow up 1 year post op |
| Case 3 | 67/M | Left HB | Infection | 4 weeks | Bilateral GPi | Resolved at 2 months | Left: C+1–, 4.5V, 60 μs, 120hz Right: 8+9–, 4.1V, 60 μs, 120hz | Bilateral STN-DBS for PD replaced with bilateral GPi-DBS |
[i] * HB-hemiballismus, HC-hemichorea, μs -microseconds, Hz- hertz, DVA – developmental venous anomaly, GPi – Globus pallidus interna, VIM – Ventral intermediate nucleus.