Delayed post-ischemic leukoencephalopathy in emergent large-vessel occlusive stroke after mechanical thrombectomy: case reports

Abstract

Background Delayed post-ischemic leukoencephalopathy (DPIL) is a rare complication after mechanical thrombectomy, with no well-established clinical characteristics and pathomechanism. We explored the characteristics and possible mechanisms in three patients with DPIL.

Case Report Based on the clinical manifestations and laboratory findings including magnetic resonance imaging, magnetic resonance spectroscopy, electroencephalography, and lumbar puncture, DPIL was diagnosed in three patients. We administered antiplatelet agents and conservative treatment. Cardioembolism, successful recanalization using a balloon guiding catheter, and fluctuating or gradually worsening neurological symptoms in delayed phase between 13 and 70 days were common features of DPIL. Diffusion-weighted imaging and fluid-attenuated inversion recovery showed high-signal intensity in the affected subcortical white matter. Laboratory findings provided no evidence of an epileptic disorder, inflammatory demyelination, or tumorous conditions.

Conclusion This report shows the characteristics and neuroradiologic images of DPIL. Among the various hypotheses, regional hypoxic-ischemic leukoencephalopathy and delayed reperfusion injury might be the pathomechanism underlying DPIL.