Delayed Leukoencephalopathy After Stenting and Coiling of Cerebral Aneurysms

A 72-year-old female patient experienced a first episode of tonic-clonic seizure. Over the previous 3 years, the patient had been treated for incidental aneurysms of the superior hypophyseal artery, the posterior communicating artery, and the posterior inferior cerebellar artery with hydrogel-coated coils, a LEO stent, and an LVIS EVO stent. Subsequent cranial magnetic resonance imaging scans performed elsewhere had shown progressive white matter lesions in the left hemisphere that were hyperintense on FLAIR. Apart from renal insufficiency, the patient had no relevant preexisting diseases. Investigation of the cerebral vessels, cerebrospinal fluid analysis, and a routine EEG yielded no diagnostic findings. Current imaging revealed extensive T2-hyperintense areas with blood–brain barrier disruption, comparable to previous findings and consistent with non-ischemic cerebral enhancing (NICE) lesions (Figure). Delayed contrast-enhancing cerebral lesions occur in less than 0.1% of cases following interventional aneurysm treatment. Virtually all cases have been observed within 12 months of an endovascular procedure. Affected individuals often have no or only nonspecific symptoms. From an etiological perspective, microemboli caused by foreign material, contrast-induced encephalopathy, and hypersensitivity reactions have been discussed. The findings presented here usually respond to glucocorticoid treatment, as was the case with our patient (Figure).

Figure

Cranial MRI

Danksagung: Die Autorin und die Autoren danken Herrn Prof. Dr. med. Martin Wiesmann, Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum RWTH Aachen und Frau Dr. med. Katharina Timpte für die freundliche Bereitstellung der Abbildung.

Dr. med. Marvin Jüchtern, Prof. Dr. med. Jörg Bernhard Schulz, Dr. med. Julia Czech, Neurologische Klinik, Universitätsklinikum RWTH Aachen, [e-mail]

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Jüchtern M, Schulz JB, Czech J: Delayed leukoencephalopathy following stenting and coiling of cerebral aneurysms. Dtsch Arztebl Int 2025; 122: 680. DOI: 10.3238/arztebl.m2025.0172