Neural damage caused by cerebral hyperperfusion after arterial bypass surgery in a patient with moyamoya disease: case report.
OBJECTIVE
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.


METHODS
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.


METHODS
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.


CONCLUSIONS
The current case suggests that cerebral hyperperfusion after vascular reconstructive surgery can cause irreversible neural damage, which results in cognitive impairment.
Ogasawara
Kuniaki
K
Department of Neurosurgery, Cyclotron Research Center, Iwate Medical University, Morioka, Japan. kuogasa@iwate-med.ac.jp
Komoribayashi
Nobukazu
N
Kobayashi
Masakazu
M
Fukuda
Takeshi
T
Inoue
Takashi
T
Yamadate
Keiko
K
Ogawa
Akira
A
D001930:Brain Injuries / Q000150:complications / Q000209:etiology*; D001931:Brain Mapping; D002318:Cardiovascular Diseases / Q000150:complications* / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000209:etiology; D003072:Cognition Disorders / Q000209:etiology / Q000473:pathology; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D007839:Functional Laterality; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications* / Q000601:surgery; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010477:Perfusion / Q000009:adverse effects*; D013702:Temporal Lobe / Q000473:pathology*; D014055:Tomography, Emission-Computed / Q000379:methods