The authors report the first case of vasogenic cerebral edema due to a cell-mediated hypersensitivity reaction to a nickel-containing aneurysm clip

ARTICLE

Case report

• Terence Tan, M.B.B.S., 
• Jin W. Tee, M.B.B.S., and 
• Tiew F. Han, M.B.B.S., F.R.A.C.S.

Department of Neurosurgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia

Abbreviations used in this paper: MCA = middle cerebral artery; PAS-D = periodic acid–Schiff diastase.

Address correspondence to: Terence Tan, M.B.B.S., Department of Neurosurgery, Level 10, Inpatient Services Building, St Vincent's Hospital Melbourne, P.O. Box 2900, Fitzroy, Victoria 3065, Australia. email: terence.tan@svhm.org.au.

Please include this information when citing this paper: published online July 4, 2014; DOI: 10.3171/2014.6.JNS132405.

Related Articles

By Keywords:

cerebral aneurysm, cell-mediated allergy, aneurysm clip, nickel,vascular disorders

Abstract

The authors report the first case of vasogenic cerebral edema due to a cell-mediated hypersensitivity reaction to a nickel-containing aneurysm clip. The patient initially presented for elective clipping of a right middle cerebral artery aneurysm, and on long-term follow-up she demonstrated relapsing-remitting cerebral edema. Four years post–aneurysm clipping, she underwent an exploratory craniotomy given unsuccessful conservative management of her headaches and imaging evidence of cerebral edema with mass effect. During surgery, gross parenchymal edema and inflammatory nodules were observed. Histopathology was consistent with a cell-mediated (Type IV) hypersensitivity reaction. Concerns regarding nickel allergy are often reported in the cardiac literature. This case highlights the possibility of nickel hypersensitivity when using nickel-containing aneurysm clips, especially in patients with known nickel allergies.

Cited by

1. Ryan D. Tackla, MD, and Andrew J. Ringer, MD. (2015) Letter to the Editor: Nickel allergy and aneurysm clips. Journal of Neurosurgery 123:1, 292-293. . Online publication date: 2015Jul1. Citation | Full Text | PDF (1707 KB)