{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T11:07:18Z","timestamp":1779361638513,"version":"3.51.4"},"reference-count":36,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"19","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,5,11]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Peri-lead edema (PLE) is a rare complication after deep brain stimulation (DBS), typically presenting with delayed onset 1\u20132 weeks postoperatively. Reported symptoms include confusion, seizures, and headache.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>The authors report the case of a 71-year-old woman with medically refractory essential tremor who underwent bilateral ventral intermediate nucleus DBS with directional leads. Immediately after surgery, she developed complete anarthria, while imaging showed correct lead placement without hemorrhage. Follow-up CT imaging on days 2 and 5 revealed progressive PLE, confirmed by T2-hyperintense signal alterations on MRI at day 8. Corticosteroid therapy was initiated, leading to gradual recovery of speech over 3 weeks. At 4 months postoperatively, the patient had favorable tremor control with residual moderate dysarthria and ataxia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case highlights that symptomatic PLE can occur acutely after DBS, mimicking vascular complications, but typically follows a favorable course with recovery under optimized management.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25801\">https:\/\/thejns.org\/doi\/10.3171\/CASE25801<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25801","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T16:15:27Z","timestamp":1778516127000},"source":"Crossref","is-referenced-by-count":0,"title":["Acute postoperative anarthria following bilateral ventral intermediate nucleus deep brain stimulation: a rare presentation of early peri-lead edema. Illustrative case"],"prefix":"10.3171","volume":"11","author":[{"given":"Robert","family":"Nickl","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Julius-Maximilians-University and University Hospital, Wuerzburg"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Fricke","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Julius-Maximilians-University and University Hospital, Wuerzburg"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Capetian","sequence":"additional","affiliation":[{"name":"Department of Neurology, Julius-Maximilians-University and University Hospital, Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian","family":"Lange","sequence":"additional","affiliation":[{"name":"Department of Neurology, Julius-Maximilians-University and University Hospital, Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0453-1135","authenticated-orcid":true,"given":"Vera","family":"Nickl","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Julius-Maximilians-University and University Hospital, Wuerzburg"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Reich","sequence":"additional","affiliation":[{"name":"Department of Neurology, Julius-Maximilians-University and University Hospital, Wuerzburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cordula","family":"Matthies","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Julius-Maximilians-University and University Hospital, Wuerzburg"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"11","key":"bib1","series-title":"Mov Disord","first-page":"1629","article-title":"Synchronized brain network associated with essential tremor as revealed by magnetoencephalography","volume":"24","author":"Schnitzler","year":"2009","unstructured":"Schnitzler AM\u00fcnks CButz MTimmermann LGross J.Synchronized brain network associated with essential tremor as revealed by magnetoencephalography. Mov Disord. 2009;24(11):1629-1635. doi:10.1002\/mds.22633"},{"key":"bib2","series-title":"World Neurosurg","first-page":"e340","article-title":"Peri-lead edema after deep brain stimulation surgery: a poorly understood but frequent complication","volume":"124","author":"Whiting","year":"2019","unstructured":"Whiting ACCatapano JSWalker CTGodzik JLambert MPonce FA.Peri-lead edema after deep brain stimulation surgery: a poorly understood but frequent complication. World Neurosurg. 2019;124:e340-e345. doi:10.1016\/j.wneu.2018.12.092"},{"issue":"3","key":"bib3","series-title":"Eur J Neurol","first-page":"533","article-title":"Peri-lead edema after deep brain stimulation surgery for Parkinson\u2019s disease: a prospective magnetic resonance imaging study","volume":"26","author":"Borellini","year":"2019","unstructured":"Borellini LArdolino GCarrabba GPeri-lead edema after deep brain stimulation surgery for Parkinson\u2019s disease: a prospective magnetic resonance imaging study. Eur J Neurol. 2019;26(3):533-539. doi:10.1111\/ene.13852"},{"issue":"7","key":"bib4","series-title":"J Clin Neurosci","first-page":"910","article-title":"Transient, symptomatic, post-operative, non-infectious hypodensity around the deep brain stimulation (DBS) electrode","volume":"18","author":"Deogaonkar","year":"2011","unstructured":"Deogaonkar MNazzaro JMMachado ARezai A.Transient, symptomatic, post-operative, non-infectious hypodensity around the deep brain stimulation (DBS) electrode. J Clin Neurosci. 2011;18(7):910-915. doi:10.1016\/j.jocn.2010.11.020"},{"issue":"3","key":"bib5","series-title":"CNS Neurosci Ther","first-page":"332","article-title":"The need to be alert to complications of peri-lead cerebral edema caused by deep brain stimulation implantation: a systematic literature review and meta-analysis study","volume":"28","author":"Tian","year":"2022","unstructured":"Tian YWang JJiang LFeng ZShi XHao Y.The need to be alert to complications of peri-lead cerebral edema caused by deep brain stimulation implantation: a systematic literature review and meta-analysis study. CNS Neurosci Ther. 2022;28(3):332-342. doi:10.1111\/cns.13802"},{"issue":"8","key":"bib6","series-title":"Neuroradiology","first-page":"1971","article-title":"Unveiling patterns of peri-lead edema after deep brain stimulation: a retrospective review of clinical and demographic factors","volume":"67","author":"Johnson","year":"2025","unstructured":"Johnson CMiller GShah SUnveiling patterns of peri-lead edema after deep brain stimulation: a retrospective review of clinical and demographic factors. Neuroradiology. 2025;67(8):1971-1978. doi:10.1007\/s00234-025-03607-z"},{"key":"bib7","series-title":"Clin Neurol Neurosurg","article-title":"Incidence and management of idiopathic peri-lead edema (IPLE) following deep brain stimulation (DBS) surgery: case series and review of the literature","volume":"234","author":"Giordano","year":"2023","unstructured":"Giordano MInnocenti NRizzi MIncidence and management of idiopathic peri-lead edema (IPLE) following deep brain stimulation (DBS) surgery: case series and review of the literature. Clin Neurol Neurosurg. 2023;234:108009. doi:10.1016\/j.clineuro.2023.108009"},{"issue":"1","key":"bib8","series-title":"J Med Case Rep","first-page":"103","article-title":"Acute symptomatic peri-lead edema 33 hours after deep brain stimulation surgery: a case report","volume":"11","author":"Schoen","year":"2017","unstructured":"Schoen NBJermakowicz WJLuca CCJagid JR.Acute symptomatic peri-lead edema 33 hours after deep brain stimulation surgery: a case report. J Med Case Rep. 2017;11(1):103. doi:10.1186\/s13256-017-1275-6"},{"issue":"1","key":"bib9","series-title":"Mov Disord","first-page":"53","article-title":"Speech and Language adverse effects after thalamotomy and deep brain stimulation in patients with movement disorders: a meta-analysis","volume":"32","author":"Alomar","year":"2017","unstructured":"Alomar SKing NKTam JBari AAHamani CLozano AM.Speech and Language adverse effects after thalamotomy and deep brain stimulation in patients with movement disorders: a meta-analysis. 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Ann Neurol. 2021;89(2):315-326. doi:10.1002\/ana.25958"},{"key":"bib14","series-title":"Surg Neurol Int","article-title":"Case report of hyperacute edema and cavitation following deep brain stimulation lead implantation","volume":"11","author":"Fenoy","year":"2020","unstructured":"Fenoy AJConner CRWithrow JSHocher AW.Case report of hyperacute edema and cavitation following deep brain stimulation lead implantation. Surg Neurol Int. 2020;11:259. doi:10.25259\/SNI_527_2019"},{"issue":"1","key":"bib15","series-title":"Deep Brain Stimul","first-page":"1","article-title":"An unusual early and persistent symptomatic presentation of peri-lead edema following deep brain stimulation: case report and literature review","volume":"1","author":"Ramos","year":"2023","unstructured":"Ramos MBBritz JPEMattana MPires de Aguiar PHFranceschini PR.An unusual early and persistent symptomatic presentation of peri-lead edema following deep brain stimulation: case report and literature review. Deep Brain Stimul. 2023;1(1):1-4. doi:10.1016\/j.jdbs.2022.09.001"},{"key":"bib16","series-title":"Surg Neurol Int","first-page":"68","article-title":"Symptomatic, left-sided deep brain stimulation lead edema 6 h after bilateral subthalamic nucleus lead placement","volume":"10","author":"Lee","year":"2019","unstructured":"Lee JJDaniels BAusterman RJDalm BD.Symptomatic, left-sided deep brain stimulation lead edema 6 h after bilateral subthalamic nucleus lead placement. Surg Neurol Int. 2019;10:68. doi:10.25259\/SNI-125-2019"},{"issue":"5","key":"bib17","series-title":"Stereotact Funct Neurosurg","first-page":"311","article-title":"Abnormal T2-weighted MRI signal surrounding leads in a subset of deep brain stimulation patients","volume":"89","author":"Englot","year":"2011","unstructured":"Englot DJGlastonbury CMLarson PS.Abnormal T2-weighted MRI signal surrounding leads in a subset of deep brain stimulation patients. Stereotact Funct Neurosurg. 2011;89(5):311-317. doi:10.1159\/000329365"},{"issue":"3","key":"bib18","series-title":"CNS Neurosci Ther","first-page":"e14470","article-title":"Postoperative use of steroids for peri-electrode edema after deep brain stimulation surgery: a retrospective cohort study","volume":"30","author":"Wu","year":"2024","unstructured":"Wu BLing YZhang CPostoperative use of steroids for peri-electrode edema after deep brain stimulation surgery: a retrospective cohort study. CNS Neurosci Ther. 2024;30(3):e14470. doi:10.1111\/cns.14470"},{"issue":"11","key":"bib1","series-title":"Mov Disord","first-page":"1629","article-title":"Synchronized brain network associated with essential tremor as revealed by magnetoencephalography","volume":"24","author":"Schnitzler","year":"2009","unstructured":"Schnitzler AM\u00fcnks CButz MTimmermann LGross J.Synchronized brain network associated with essential tremor as revealed by magnetoencephalography. 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J Clin Neurosci. 2011;18(7):910-915. doi:10.1016\/j.jocn.2010.11.020"},{"issue":"3","key":"bib5","series-title":"CNS Neurosci Ther","first-page":"332","article-title":"The need to be alert to complications of peri-lead cerebral edema caused by deep brain stimulation implantation: a systematic literature review and meta-analysis study","volume":"28","author":"Tian","year":"2022","unstructured":"Tian YWang JJiang LFeng ZShi XHao Y.The need to be alert to complications of peri-lead cerebral edema caused by deep brain stimulation implantation: a systematic literature review and meta-analysis study. CNS Neurosci Ther. 2022;28(3):332-342. doi:10.1111\/cns.13802"},{"issue":"8","key":"bib6","series-title":"Neuroradiology","first-page":"1971","article-title":"Unveiling patterns of peri-lead edema after deep brain stimulation: a retrospective review of clinical and demographic factors","volume":"67","author":"Johnson","year":"2025","unstructured":"Johnson CMiller GShah SUnveiling patterns of peri-lead edema after deep brain stimulation: a retrospective review of clinical and demographic factors. Neuroradiology. 2025;67(8):1971-1978. doi:10.1007\/s00234-025-03607-z"},{"key":"bib7","series-title":"Clin Neurol Neurosurg","article-title":"Incidence and management of idiopathic peri-lead edema (IPLE) following deep brain stimulation (DBS) surgery: case series and review of the literature","volume":"234","author":"Giordano","year":"2023","unstructured":"Giordano MInnocenti NRizzi MIncidence and management of idiopathic peri-lead edema (IPLE) following deep brain stimulation (DBS) surgery: case series and review of the literature. Clin Neurol Neurosurg. 2023;234:108009. doi:10.1016\/j.clineuro.2023.108009"},{"issue":"1","key":"bib8","series-title":"J Med Case Rep","first-page":"103","article-title":"Acute symptomatic peri-lead edema 33 hours after deep brain stimulation surgery: a case report","volume":"11","author":"Schoen","year":"2017","unstructured":"Schoen NBJermakowicz WJLuca CCJagid JR.Acute symptomatic peri-lead edema 33 hours after deep brain stimulation surgery: a case report. J Med Case Rep. 2017;11(1):103. doi:10.1186\/s13256-017-1275-6"},{"issue":"1","key":"bib9","series-title":"Mov Disord","first-page":"53","article-title":"Speech and Language adverse effects after thalamotomy and deep brain stimulation in patients with movement disorders: a meta-analysis","volume":"32","author":"Alomar","year":"2017","unstructured":"Alomar SKing NKTam JBari AAHamani CLozano AM.Speech and Language adverse effects after thalamotomy and deep brain stimulation in patients with movement disorders: a meta-analysis. 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NeuroImage Clin. 2020;26:102235. doi:10.1016\/j.nicl.2020.102235"},{"key":"bib12","series-title":"World Neurosurg","first-page":"e89","article-title":"Thalamic deep brain stimulation for essential tremor: relation of the dentatorubrothalamic tract with stimulation parameters","volume":"137","author":"Yang","year":"2020","unstructured":"Yang AIBuch VPHeman-Ackah SMThalamic deep brain stimulation for essential tremor: relation of the dentatorubrothalamic tract with stimulation parameters. World Neurosurg. 2020;137:e89-e97. doi:10.1016\/j.wneu.2020.01.039"},{"issue":"2","key":"bib13","series-title":"Ann Neurol","first-page":"315","article-title":"Network fingerprint of stimulation-induced speech impairment in essential tremor","volume":"89","author":"Petry-Schmelzer","year":"2021","unstructured":"Petry-Schmelzer JNJergas HThies TNetwork fingerprint of stimulation-induced speech impairment in essential tremor. Ann Neurol. 2021;89(2):315-326. doi:10.1002\/ana.25958"},{"key":"bib14","series-title":"Surg Neurol Int","article-title":"Case report of hyperacute edema and cavitation following deep brain stimulation lead implantation","volume":"11","author":"Fenoy","year":"2020","unstructured":"Fenoy AJConner CRWithrow JSHocher AW.Case report of hyperacute edema and cavitation following deep brain stimulation lead implantation. Surg Neurol Int. 2020;11:259. doi:10.25259\/SNI_527_2019"},{"issue":"1","key":"bib15","series-title":"Deep Brain Stimul","first-page":"1","article-title":"An unusual early and persistent symptomatic presentation of peri-lead edema following deep brain stimulation: case report and literature review","volume":"1","author":"Ramos","year":"2023","unstructured":"Ramos MBBritz JPEMattana MPires de Aguiar PHFranceschini PR.An unusual early and persistent symptomatic presentation of peri-lead edema following deep brain stimulation: case report and literature review. 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