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cerebral hyperperfusion

Chao Fu, Zhongxin Xu, Zhenzhen Hu, Shuai Yao, Fengmin Liu, Baiqi Feng, Conghai Zhao, Weidong Yu
Cerebral hyperperfusion syndrome (CHS) is a well-documented complication after carotid endarterectomy or stenting. In contrast, CHS following vertebral revascularization is extremely rare. Here we present a case of a 77-year-old man with high-grade vertebral stenosis who subsequently underwent balloon angioplasty, complicated by hemorrhagic CHS manifesting as cortical blindness, although strict postoperative blood pressure control was administered. To our knowledge, cortical blindness as a presentation of hemorrhagic CHS has not previously been reported...
March 21, 2018: Journal of Neurointerventional Surgery
Kathryn F Kirchoff-Torres, Ekaterina Bakradze
PURPOSE OF REVIEW: Cerebral hyperperfusion syndrome (CHS) is a rare but significant complication after carotid revascularization and is increasingly recognized after acute stroke treatments. In this review, we discuss the epidemiology and pathophysiology of CHS, clinical presentation including ipsilateral headache, seizures, and focal neurological deficits, and radiographic presentation. We propose preventive therapies with emphasis on acute stroke post-thrombectomy hyperperfusion. RECENT FINDINGS: CHS was first described after carotid revascularization but is now also reported in patients with acute ischemic stroke...
March 19, 2018: Current Pain and Headache Reports
Rumiko Takayama, Katsumi Imai, Hiroko Ikeda, Koichi Baba, Naotaka Usui, Yukitoshi Takahashi, Yushi Inoue
We describe two cases of refractory epilepsy with cerebral hemiatrophy and contralateral electroencephalographic (EEG) abnormalities, in which hemispherotomy of the atrophic hemisphere effectively controlled seizures. Case 1 was a 5-year-1-month-old girl with refractory bilateral asymmetrical tonic posturing seizures predominantly in the right arm. Magnetic resonance imaging showed left porencephaly corresponding to a left middle cerebral artery infarction. Case 2 was a 3-year-8-month-old boy with refractory bilateral asymmetrical tonic posturing seizures predominantly in the right arm due to atrophy of the left cerebral hemisphere after septic meningitis...
March 14, 2018: Brain & Development
Takuma Ohmichi, Masaki Kondo, Masahiro Itsukage, Hidetaka Koizumi, Shigenori Matsushima, Nagato Kuriyama, Kazunari Ishii, Etsuro Mori, Kei Yamada, Toshiki Mizuno, Takahiko Tokuda
OBJECTIVE The gold standard for the diagnosis of idiopathic normal pressure hydrocephalus (iNPH) is the CSF removal test. For elderly patients, however, a less invasive diagnostic method is required. On MRI, high-convexity tightness was reported to be an important finding for the diagnosis of iNPH. On SPECT, patients with iNPH often show hyperperfusion of the high-convexity area. The authors tested 2 hypotheses regarding the SPECT finding: 1) it is relative hyperperfusion reflecting the increased gray matter density of the convexity, and 2) it is useful for the diagnosis of iNPH...
March 16, 2018: Journal of Neurosurgery
Ken Kazumata, Haruto Uchino, Kikutaro Tokairin, Masaki Ito, Tohru Shiga, Toshiya Osanai, Masahito Kawabori
BACKGROUND: Cerebral hyperperfusion complicates the postoperative course of patients with moyamoya disease (MMD) following direct revascularization surgery. There is no clear distinction between cerebral hyperperfusion syndrome and benign postoperative increase in regional cerebral blood flow (rCBF). OBJECTIVE: The present study aimed to determine clinically relevant changes in rCBF, anatomical correlations, and factors associated with transient neurological symptoms following revascularization surgery in MMD...
March 9, 2018: World Neurosurgery
Kouichi Misaki, Naoyuki Uchiyama, Anri Inaki, Seigo Kinuya, Iku Nambu, Tomoya Kamide, Masanao Mohri, Yasuhiko Hayashi, Mitsutoshi Nakada
BACKGROUND AND PURPOSE: Hemodynamic impairments are considered risk factors of cerebral hyperperfusion after carotid artery stenting (CAS); measurement by SPECT using a subjective ROI method lacks consistency and reproducibility. MATERIALS AND METHODS: The present study compared objective perfusion analysis (stereotactic extraction estimation [SEE] method) with the ROI method for preoperative SPECT to predict the hyperperfusion phenomenon (HPP) after CAS. Preoperative resting asymmetry index (CBF ratio from the affected to unaffected hemisphere) and cerebrovascular reactivity (CVR) to acetazolamide were measured by N-isopropyl-p-[123 I]-iodoamphetamine SPECT using the SEE and ROI method in 84 patients...
March 7, 2018: Journal of Neuroradiology. Journal de Neuroradiologie
Ralph Rahme, Tejaswi D Sudhakar, Marjan Alimi, Timothy G White, Rafael A Ortiz, David J Langer
BACKGROUND AND IMPORTANCE: Cerebral hyperperfusion syndrome (CHS) is a well-known complication of superficial temporal artery (STA) to middle cerebral artery (MCA) bypass for ischemic cerebrovascular disease. While this argues against "low flow" in the bypass construct, flow rates in the graft have not been previously quantified in the setting of CHS. CLINICAL PRESENTATION: A 58-yr-old man presented with recurrent left hemispheric ischemic strokes and fluctuating right hemiparesis and aphasia...
March 3, 2018: Operative Neurosurgery (Hagerstown, Md.)
Tomonori Iwata, Takahisa Mori, Yuhei Tanno, Shigen Kasakura, Kazuhiro Yoshioka
BACKGROUND: Cerebral hyperperfusion syndrome (CHS) is likely to occur after carotid revascularization in patients with stage 2 hemodynamic failure (st2HF), in whom the oxygen extraction fraction (OEF) increases. OBJECTIVE: The purpose of our study was to investigate whether measurement of the global cerebral OEF (gcOEF) by blood sampling can be used to estimate st2HF and anticipate CHS following carotid artery stenting (CAS). METHODS: The OEF was calculated by blood sampling just before and after elective CAS...
March 6, 2018: Journal of Neurointerventional Surgery
Meng Luen Lee, Ming Yuh Chang, Tung Ming Chang, Rei Cheng Yang, Ming Che Chang, Albert D Yang
Concurrent involvement of bilateral renal and cerebral arteries, usually incurred as stenosis, is rare in childhood-onset Takayasu arteritis (c-TA). We report the case of a 14-year-old girl, with c-TA, presenting with transient ischemic attack after endovascular revascularization for renal artery stenosis and cerebrovascular stroke after surgical revascularization for cerebral artery stenosis associated with childhood-onset moyamoya syndrome. We deem that decrease of blood pressure by endovascular revascularization and improvement of cerebral perfusion by surgical revascularization may have jeopardized the cerebral deep watershed zone to cerebral ischemia followed by cerebral hyperperfusion syndrome and caused transient ischemic attack and cerebrovascular stroke in our patient...
March 5, 2018: Journal of Korean Medical Science
Jeffrey R Sachs, Michael E Zapadka, Gautam S Popli, Jonathan H Burdette
Anti-N-methyl-d-aspartate receptor encephalitis is an increasingly recognized autoimmune disorder that results in substantial morbidity, prolonged hospital stays, and even death. The diagnosis is often delayed or unrecognized entirely as a result of absent or only subtle initial magnetic resonance imaging findings and a nonspecific clinical syndrome. The discovery of early imaging findings in this disease may help clinicians to more aggressively treat this autoimmune encephalitis and to potentially lessen morbidity and mortality...
December 2017: Radiology Case Reports
Kimitoshi Sato, Shun Tsudaka, Takanori Miki, Norikata Kobayashi, Taro Yamashita, Kiyoharu Imataka, Takashi Yoshida, Fuminori Shimizu
The concept of "watershed shift"(WS)has been proposed as a cause of the ischemic complications following a superficial temporal artery-middle cerebral artery(STA-MCA)bypass operation performed for the management of moyamoya disease. Previous reports have observed that only 1.2-5.7% of the patients who underwent a bypass operation for the management of moyamoya disease developed cerebral infarction secondary to the WS phenomenon. To date, the WS phenomenon has not been objectively proven on imaging studies...
February 2018: No Shinkei Geka. Neurological Surgery
Salvatore Rudilosso, Carlos Laredo, Marco Mancosu, Nuria Moya-Planas, Yashu Zhao, Oscar Chirife, Ángel Chamorro, Xabier Urra
Hypoperfusion is the typical perfusion pattern associated with recent small subcortical infarcts of the brain, but other perfusion patterns may be present in patients with these infarcts. Using CT perfusion, we studied 67 consecutive patients who had a small subcortical infarct at a follow-up MRI study to investigate the correlation between the perfusion pattern and the clinical and radiological course. On CT perfusion map analysis, 51 patients (76%) had focal hypoperfusion, 4 patients (6%) had hyperperfusion and the remaining 12 patients (18%) showed no abnormalities...
January 1, 2018: Journal of Cerebral Blood Flow and Metabolism
Baofeng Xu, Chao Li, Yunbao Guo, Kan Xu, Yi Yang, Jinlu Yu
At present, there is limited understanding of chronic total occlusion (CTO) of the internal carotid artery (ICA). Therefore, the present report collected related cases from PubMed and reviewed the literature. Cerebral vessels may form collateral circulation immediately or gradually following CTO of the ICA. The natural history of CTO of the ICA includes a variety of outcomes, all of which are biased toward a non-benign progressive process and are characterized by insufficient cerebral perfusion, embolus detachment and cognitive dysfunction...
February 2018: Biomedical Reports
Ryo Hiramatsu, Motomasa Furuse, Ryokichi Yagi, Tomohisa Ohmura, Hiroyuki Ohnishi, Naokado Ikeda, Naosuke Nonoguchi, Shinji Kawabata, Shigeru Miyachi, Toshihiko Kuroiwa
BACKGROUND: The frequency of the occurrence of adverse events associated with carotid artery stenting (CAS) is usually low, but serious adverse events such as cerebral hyperperfusion syndrome (CHS) may occur. Real-time monitoring is ideal for the early detection of adverse events during the surgical procedure. This study aimed to evaluate continuous blood glucose (BG) monitoring for the detection of adverse events during CAS. METHODS: Forty patients undergoing scheduled CAS were prospectively enrolled...
February 5, 2018: Annals of Vascular Surgery
Lucia Rivera-Lara, Andres Zorrilla-Vaca, Ryan J Healy, Wendy Ziai, Charles Hogue, Romergryko Geocadin, Batya Radzik, Caitlin Palmisano, Marek A Mirski
OBJECTIVE: Critical care guidelines recommend a single target value for mean arterial blood pressure in critically ill patients. However, growing evidence regarding cerebral autoregulation challenges this concept and supports individualizing mean arterial blood pressure targets to prevent brain and kidney hypo- or hyperperfusion. Regional cerebral oxygen saturation derived from near-infrared spectroscopy is an acceptable surrogate for cerebral blood flow and has been validated to measure cerebral autoregulation...
February 6, 2018: Critical Care Medicine
Hea Ree Park, Min Jae Seong, Young-Min Shon, Eun Yeon Joo, Dae-Won Seo, Seung Bong Hong
Ictal automatism with preserved responsiveness (APR) has been reported, particularly in nondominant temporal lobe epilepsy (TLE), but its pathophysiology remains poorly understood. This study sought to investigate the relationship between APRs and increased cerebral blood flow (CBF) using ictal single photon emission computed tomography (SPECT) in TLE. Forty-seven subjects with right mesial TLE (15 with and 32 without APR) were enrolled. Patients with APR (APR+) were subdivided into four groups according to degree of responsiveness during seizures...
January 19, 2018: Epilepsy & Behavior: E&B
Mohamad A Hussain, Aziz S Alali, Muhammad Mamdani, Jack V Tu, Gustavo Saposnik, Konard Salata, Avery B Nathens, Charles de Mestral, Deepak L Bhatt, Subodh Verma, Mohammed Al-Omran
OBJECTIVE Intracranial hemorrhage (ICH) associated with cerebral hyperperfusion syndrome is a rare but major complication of carotid artery revascularization. The objective of this study was to compare the rate of ICH after carotid artery stenting (CAS) with that after endarterectomy (CEA). METHODS The authors performed a retrospective population-based cohort study of patients who underwent carotid artery revascularization in the province of Ontario, Canada, between 2002 and 2015. The primary outcome was the rate of ICH that occurred within 90 days after carotid artery intervention among patients who underwent CAS versus that of those who underwent CEA...
February 2, 2018: Journal of Neurosurgery
Shinpei Sato, Daigo Kojima, Yasuyoshi Shimada, Jun Yoshida, Kentaro Fujimato, Shunrou Fujiwara, Masakazu Kobayashi, Yoshitaka Kubo, Kenji Yoshida, Kazunori Terasaki, Shouta Tsutsui, Kenya Miyoshi, Kuniaki Ogasawara
The present study examined whether preoperatively reduced cerebrovascular contractile reactivity to hypocapnia by hyperventilation is associated with development of cerebral hyperperfusion syndrome after arterial bypass surgery for adult patients with cerebral misery perfusion due to ischemic moyamoya disease. Among 65 adult patients with ischemic moyamoya disease, 19 had misery perfusion in the precentral region on preoperative15 O positron emission tomography and underwent arterial bypass surgery for that region...
January 1, 2018: Journal of Cerebral Blood Flow and Metabolism
Hideaki Nagashima, Tomoru Miwa, Takashi Horiguchi, Ryosuke Tomio, Yu Nakagawa, Kazunari Yoshida
BACKGROUND: Cerebral vasospasm is an uncontrollable and sometimes fatal complication occurring after subarachnoid hemorrhage. However, cerebral hyperperfusion syndrome is a rare complication after subarachnoid hemorrhage. Although plain computed tomography of cerebral hyperperfusion syndrome looks similar to cerebral infarction induced by cerebral vasospasm, they should be distinguished from each other because they require completely different treatments. CASE DESCRIPTION: A 65-year-old man complained of severe headache and vomiting...
January 17, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Małgorzata Neska-Matuszewska, Joanna Bladowska, Marek Sąsiadek, Anna Zimny
INTRODUCTION: In conventional MR examinations glioblastomas multiforme (GBMs), metastases and primary CNS lymphomas (PCNSLs) may show very similar appearance. The aim of the study was to evaluate usefulness of multiparametric T2*DSC perfusion and diffusion MR imaging in the preoperative differentiation of these tumors. MATERIAL AND METHODS: Seventy four solitary enhancing tumors (27 GBMs, 30 metastases, 17 PCNSLs) were enrolled in the study. Parameters of cerebral blood volume (rCBV), peak height (rPH), percentage of signal recovery (rPSR) and apparent diffusion coefficient (ADC) were assessed from the tumor core and the peritumoral non-enhancing T2-hyperintense zone...
2018: PloS One
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