• Erin D'Agostino, Vyacheslav Makler, and David F Bauer.
• Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA.
• World Neurosurg. 2018 Jun 1; 114: 165-167.

BackgroundVagal nerve stimulation is a safe and well-tolerated treatment for drug-resistant epilepsy. Complications and failure of the device can result from lead fracture, device malfunction, disconnection, or battery displacement and can result in a variety of symptoms. We present an interesting case of stimulator malfunction with increased impedance change seen only with a change in head position.Case DescriptionThe patient is a 25-year-old male with a vagal nerve stimulator (VNs) placed for medically refractory epilepsy who presented with neck pain and an electrical pulling sensation in his neck whenever he turned his head to the right. Initial interrogation of the VNs showed normal impedance. Subsequent interrogation with the patient's head turned found increased impedance only when the head was turned to the right. The patient had successful removal and replacement of the device with resolution of his preoperative complaints. Partial lead fracture was seen at explant.ConclusionVNs malfunction can present in atypical ways. Positional maneuvers may help with its timely diagnosis.Copyright © 2018 Elsevier Inc. All rights reserved.

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