Delayed cerebral complications associated with endovascular catheter coil embolization for pulmonary venous shunts mimicking cerebral inflammatory diseases

IntroductionHydrophilic polymer embolism in the brain is a delayed complication of cerebral angiography or endovascular therapy. Herein, we report a rare case of a hydrophilic polymer embolism in the brain due to endovascular catheter coil embolization of pulmonary venous shunts.Case reportA 16-year-old female presented with headache, dizziness, nausea, and dysesthesia in the left upper limb. Brain magnetic resonance imaging (MRI) revealed multiple bilateral subcortical white matter lesions with nodular gadolinium enhancement lesions surrounded with edema. Two weeks before onset, the patient underwent endovascular catheter coil embolization with two coils for two systemic-to-pulmonary venous shunts. We suspected that her multiple cerebral lesions were delayed allergic complications due to a catheter hydrophilic polymer-coating embolism after endovascular catheter coil embolization. Corticosteroid treatment rapidly improved neurological symptoms and MRI findings.ConclusionTo avoid unnecessary brain biopsy, careful history taking of previous catheterization is essential among patients presenting with focal deficits and punctate-enhancing brain lesions for the diagnosis of hydrophilic polymer embolism.