Delayed intracerebral hemorrhage: A rare complication of deep brain stimulation surgery

Background/aims: Deep brain stimulation (DBS) has been a proven safe treatment option for a variety of neurological diseases. Nonetheless, it carries various potential risks including intracerebral hemorrhage (ICH), cerebral ischemia, seizures, and infection. The majority of hemorrhages are found immediately post-operatively; however, delayed hemorrhages, which are extremely rare, have been reported. Methods: Case presentation of a patient who developed a large ICH after undergoing bilateral DBS lead placement for dystonia with an initial negative CT scan immediately after surgery, as well as a negative 24 hour post-operative scan. Literature review on delayed ICH in DBS surgery was performed. Results: The risk of ICH, both asymptomatic and those causing neurologic deficit, have been reported ranging from 0.5–6.7%. The majority of those reported have been found on immediate post-operative imaging; however, there have been few reports of delayed ICH that were not present on the initial post-operative scan. Conclusion: DBS is a safe surgical option for patients with various neurological and movement disorders. Although the risk of ICH is low, delayed hemorrhages are possible and can be a devastating complication all clinicians must be aware of and be prepared for in order to better manage and treat patients.