Cell-mediated allergy to cerebral aneurysm clip causing extensive cerebral edema

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.
View More View Less
  • Department of Neurosurgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

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.

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

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

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.

  • 1

    David CA, , Vishteh AG, , Spetzler RF, , Lemole M, , Lawton MT, & Partovi S: Late angiographic follow-up review of surgically treated aneurysms. J Neurosurg 91:396401, 1999

    • Search Google Scholar
    • Export Citation
  • 2

    Ebina K, , Iwabuchi T, & Suzuki S: Histological change in permanently clipped or ligated cerebral arterial wall. Part II: Autopsy cases of aneurysmal neck clipping. Acta Neurochir (Wien) 66:2342, 1982

    • Search Google Scholar
    • Export Citation
  • 3

    International Organization for Standardization: International Standard ISO 5832-7. Implants for surgery—metallic materials— Part 7: forgeable and cold-formed cobalt-chromium-nickel-molybdenum-iron alloy Geneva, ISO, 1994

    • Search Google Scholar
    • Export Citation
  • 4

    Jeswani S, & Alexander MJ: Nickel allergy: a reason for concern?. J Neurointerv Surg 3:24, 2011

  • 5

    Minang JT, , Areström I, , Troye-Blomberg M, , Lundeberg L, & Ahlborg N: Nickel, cobalt, chromium, palladium and gold induce a mixed Th1- and Th2-type cytokine response in vitro in subjects with contact allergy to the respective metals. Clin Exp Immunol 146:417426, 2006

    • Search Google Scholar
    • Export Citation
  • 6

    Otawara Y, , Endo MM, , Ogasawara K, , Kubo Y, , Ogawa A, & Watanabe K: Reliability of cobalt-chromium alloy aneurysm clips after long-term implantations in patients with cerebral aneurysms. J Neurosurg 105:713716, 2006

    • Search Google Scholar
    • Export Citation
  • 7

    Otawara Y, , Ogasawara K, , Kubo Y, , Kashimura H, , Ogawa A, & Watanabe K: Mechanical and surface properties of Yasargil Phynox aneurysm clips after long-term implantation in a patient with cerebral aneurysm. Neurosurg Rev 32:193197, 2009

    • Search Google Scholar
    • Export Citation
  • 8

    Ross IB, , Warrington RJ, & Halliday WC: Cell-mediated allergy to a cerebral aneurysm clip: case report. Neurosurgery 43:12091211, 1998

  • 9

    Ulus S, , Yakupoğlu A, , Kararslan E, , Işlak C, , Siva A, & Koçer N: Reversible intracranial parenchymal changes in MRI after MCA aneurysm treatment with stent-assisted coiling technique; possible nickel allergy. Neuroradiology 54:897899, 2012

    • Search Google Scholar
    • Export Citation
  • 10

    Warshaw EM, , Belsito DV, , Taylor JS, , Sasseville D, , DeKoven JG, & Zirwas MJ, : North American Contact Dermatitis Group patch test results: 2009 to 2010. Dermatitis 24:5059, 2013

    • Search Google Scholar
    • Export Citation
  • 11

    Wertman B, , Azarbal B, , Riedl M, & Tobis J: Adverse events associated with nickel allergy in patients undergoing percutaneous atrial septal defect or patent foramen ovale closure. J Am Coll Cardiol 47:12261227, 2006

    • Search Google Scholar
    • Export Citation
  • 12

    Wichmann W, , Von Ammon K, , Fink U, , Weik T, & Yaşargil GM: Aneurysm clips made of titanium: magnetic characteristics and artifacts in MR. AJNR Am J Neuroradiol 18:939944, 1997

    • Search Google Scholar
    • Export Citation

Metrics