Neural damage caused by cerebral hyperperfusion after arterial bypass surgery in a patient with Moyamoya disease: Case report
Neural damage caused by cerebral hyperperfusion after arterial bypass surgery in a patient with Moyamoya disease: Case report
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DOI：
10.1227/01.neu.0000159719.47528.2e
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发表时间：
2005-06-01
期刊：
影响因子：
4.8
通讯作者：
Ogawa, A
中科院分区：
文献类型：
--
作者：
Ogasawara, K;Komoribayashi, N;Ogawa, A
目标和重要性：脑过度灌注综合征的预后血管重建手术后，包括颅外-颅内动脉搭桥术，是不是穷人，除非脑出血继发hyperperfusion. Clinical介绍：一个48岁的男子有症状的烟雾病与痛苦灌注在右大脑半球进行了双右颞浅动脉大脑中动脉旁路。术后过程是平安无事的，直到病人出现头痛和激动性谵妄的术后第4天。干预：灌注计算机断层扫描成像显示在右颞叶灌注过度。通过强化血压控制，症状消退。术后2个月进行的正电子发射断层扫描显示右颞叶的脑氧代谢率术后降低，术后3个月在磁共振成像上观察到脑萎缩。术后3个月进行的神经心理学测试显示恶化的数字跨度，这对患者的生活quality.CONCLUSION：目前的情况表明，血管重建手术后脑灌注过多会导致不可逆的神经损伤，从而导致认知功能障碍。
OBJECTIVE AND IMPORTANCE: The prognosis of cerebral hyperperfusion syndrome after vascular reconstructive surgery, including extracranial-intracranial arterial bypass, is not poor unless intracerebral hemorrhage develops secondary to hyperperfusion.CLINICAL PRESENTATION: A 48-year-old man with symptomatic moyamoya disease with misery perfusion in the right cerebral hemisphere underwent double right superficial temporal artery-to-middle cerebral artery bypasses. The postoperative course was uneventful until the patient developed headache and agitated delirium on the 4th postoperative day.INTERVENTION: Perfusion computed tomographic imaging demonstrated hyperperfusion in the right temporal lobe. The symptoms resolved by institution of intensive blood pressure control. Positron emission tomography performed 2 months after surgery demonstrated a postoperative reduction of the cerebral metabolic rate of oxygen in the right temporal lobe, where brain atrophy was observed on magnetic resonance images 3 months postoperatively. Neuropsychological testing performed 3 months postoperatively showed worsening digit span, which adversely affected the patient's quality of life.CONCLUSION: The current case suggests that cerebral hyperperfusion after vascular reconstructive surgery can cause irreversible neural damage, which results in cognitive impairment.