Interdisciplinary Neurosurgery (Sep 2022)
A case report: A preoperative increase in cerebral blood volume, not the oxygen extraction fraction, induces postoperative cerebral hyperperfusion syndrome regardless of procedure for revascularization
Abstract
Background: Cerebral hyperperfusion syndrome (CHS) is a relatively rare but critical perioperative complication after CEA and CAS. We herein report a case with a preoperative increase in CBV, not OEF, in a patient who suffered from CHS both after CEA and after CAS for the same lesion. Case description: An 82-year-old female with a history of transient right hemiparesis was admitted to our hospital. 3DCTA demonstrated severe stenosis of the left neck ICA with severe calcification. 15O-PET indicated an increase of CBV was observed, but an increase of OEF was not observed in the left MCA territory. She underwent left CEA and suffered from CHS. After four months of left CEA, she suffered from right hemiparesis and was admitted to our hospital. MRI DWI revealed a spotty high signal lesion in the left frontal subcortex due to re-stenosis of the left neck ICA following CEA. She underwent CAS and suffered from CHS again. Finally, she was discharged home with mRS1. Conclusion: To our knowledge, no previous reports have described CHS after CEA and CAS for the same lesion, as occurred in our case. This case could suggest that regardless of CEA and CAS procedures, an increase of CBV was related to CHS rather than the longstanding chronic ischemia, which might increase OEF.
