Symptomatic hyperperfusion after superficial temporal artery-middle cerebral artery anastomosis in a child with moyamoya disease.
OBJECTIVE
Surgical revascularization for moyamoya disease prevents cerebral ischemic attacks by improving cerebral blood flow (CBF). It is undetermined, however, how rapid increase in CBF affects ischemic brain at acute stage, especially in children.


METHODS
A 4-year-old girl with moyamoya disease underwent right superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis. She suffered temporary left facial palsy 5 days after surgery. Postoperative N-isopropyl-p-[123I]iodoamphetamine single-photon emission computed tomography (123I-IMP-SPECT) revealed focal intense increase in CBF at the sites of anastomosis. Magnetic resonance imaging/angiography showed the apparently patent STA-MCA anastomosis as a thick high signal without ischemic changes. Her symptom improved 9 days after surgery, and single-photon emission computed tomography (SPECT) 2 months later showed normalization of CBF. Surgical revascularization completely relieved the transient ischemic attack on her left hand that was seen before surgery.


CONCLUSIONS
We demonstrated, for the first time, that delayed focal neurological deficit after STA-MCA anastomosis can be caused by focal hyperperfusion in childhood moyamoya disease.
Fujimura
Miki
M
Department of Neurosurgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan. fujimur@nsg.med.tohoku.ac.jp
Kaneta
Tomohiro
T
Shimizu
Hiroaki
H
Tominaga
Teiji
T
D000714:Anastomosis, Surgical; D002533:Cerebral Angiography; D002548:Cerebral Revascularization / Q000009:adverse effects*; D002560:Cerebrovascular Circulation / Q000502:physiology; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D002675:Child, Preschool; D005158:Facial Paralysis / Q000209:etiology; D005260:Female; D006801:Humans; D020367:Iofetamine; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000601:surgery; D018810:Magnetic Resonance Angiography; D020768:Middle Cerebral Artery / Q000601:surgery*; D009072:Moyamoya Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology*; D019275:Radiopharmaceuticals; D013699:Temporal Arteries / Q000601:surgery*; D015899:Tomography, Emission-Computed, Single-Photon
D019275:Radiopharmaceuticals; D020367:Iofetamine