Chemical Meningitis after Cerebral Aneurysm Treatment Using Two Second-generation Aneurysm Coils: Report of Two Cases

Abstract

Second-generation aneurysm coils were developed to promote more durable occlusion of cerebral aneurysms by promoting more complete volumetric aneurysm occlusion or by eliciting a more prolific inflammatory response. The concurrent use of Hydrogel and Matrix coil systems in large aneurysms may cause an exuberant inflammatory response with both local and systemic manifestations. Although vigilant evaluation and treatment for presumptive bacterial meningitis is required in all such cases, patients respond to immunomodulatory therapy with corticosteroids. More information to understand better the interaction of Hydrogel and Matrix coils is needed.

Angiographic and Clinical Outcomes in 200 Consecutive Patients with Cerebral Aneurysm Treated with Hydrogel-Coated Coils

“…There has been previously documented concern regarding aseptic meningitis following HydroCoil treatment of unruptured intracranial aneurysms, 6,44 which occurred in 1.5% of patients in this series. The pathophysiology of this phenomenon is currently unknown, but the condition seems to respond well to steroids or ventricular shunt surgery.…”

Hydrogel versus Bare Platinum Coils in Patients with Large or Recurrent Aneurysms Prone to Recurrence after Endovascular Treatment: A Randomized Controlled Trial

“…14,22,[24][25][26][27] In PRET, adverse events that have been (rightly or wrongly) attributed to inflammation were transient and occurred rarely and with equal frequency in both groups.…”

Hydrophilic polymer emboli: an under-recognized iatrogenic cause of ischemia and infarct

“…After cardiac catheterization and coronary angiography procedures, this has manifested clinically as painful, non-healing dermal wounds at the access site, [5][6][7][8][9][10] shown on biopsy to be extravascular or perivascular granulomata harboring extracellular deposits of polymer material (likely originating from coated Cook arterial introducer sheaths). 'Aseptic' and 'chemical' meningitis, documented in five patients, 11,12 likely resulted from disseminated polymer materials (although clinical findings in these cases were not confirmed by histopathologic evaluation). Intracerebral filament core has been shown in two patients with neurologic deficits after coil embolization procedures using Cerecyte (Micrus Endo-vascular, San Jose, CA, USA) 9 and Matrix (Boston Scientific Neuro-vascular, Fremont, CA, USA) 13 detachable coils.…”