Acute postoperative anarthria following bilateral ventral intermediate nucleus deep brain stimulation: a rare presentation of early peri-lead edema. Illustrative case

BACKGROUND: Peri-lead edema (PLE) is a rare complication after deep brain stimulation (DBS), typically presenting with delayed onset 1-2 weeks postoperatively. Reported symptoms include confusion, seizures, and headache. OBSERVATIONS: The authors report the case of a 71-year-old woman with medically refractory essential tremor who underwent bilateral ventral intermediate nucleus DBS with directional leads. Immediately after surgery, she developed complete anarthria, while imaging showed correct lead placement without hemorrhage. Follow-up CT imaging on days 2 and 5 revealed progressive PLE, confirmed by T2-hyperintense signal alterations on MRI at day 8. Corticosteroid therapy was initiated, leading to gradual recovery of speech over 3 weeks. At 4 months postoperatively, the patient had favorable tremor control with residual moderate dysarthria and ataxia. LESSONS: This case highlights that symptomatic PLE can occur acutely after DBS, mimicking vascular complications, but typically follows a favorable course with recovery under optimized management. https://thejns.org/doi/10.3171/CASE25801.