MRI evidence of reperfusion injury associated with neurological deficits after carotid revascularization procedures.
OBJECTIVE
Some patients develop major neurological complications after carotid revascularization procedures, despite the lack of new infarcts or classical hyperperfusion syndrome.


METHODS
In four patients who developed major neurological deficits after carotid revascularization procedures, but without evidence of new ischemic infarcts or hyperperfusion, we performed post-procedural MRI [diffusion-weighted image (DWI), perfusion-weighted image (PWI), pre-and post-contrast fluid-attenuated inversion recovery (FLAIR) image] immediately after and 1 day after the procedure.


RESULTS
Post-gadolinium FLAIR images on 1 day after the procedures showed prominent leptomeningeal enhancements in the revascularized hemispheres. These radiological findings disappeared on follow-up FLAIR images accompanied by the clinical improvement over the following several days after the procedures.


CONCLUSIONS
Reperfusion syndrome may be associated with transient severe neurological deficits after carotid revascularization in patients without new ischemic events or classical hyperperfusion syndrome.
Cho
A-H
AH
Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Suh
D-C
DC
Kim
G E
GE
Kim
J S
JS
Lee
D H
DH
Kwon
S U
SU
Park
S M
SM
Kang
D-W
DW
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D002339:Carotid Arteries / Q000503:physiopathology; D002548:Cerebral Revascularization / Q000009:adverse effects*; D003952:Diagnostic Imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology* / Q000503:physiopathology; D015427:Reperfusion Injury / Q000150:complications* / Q000503:physiopathology