title: Incidence and clinical features of symptomatic cerebral hyperperfusion syndrome after vascular reconstruction.
abstract: BACKGROUND
  Vascular reconstructions are the established treatment for ischemic cerebrovascular disease. Cerebral hyperperfusion syndrome (CHS) is occasionally seen after vascular reconstruction and manifest clinical symptoms. The purpose of this study is to investigate the incidence and clinical features of CHS after vascular reconstruction.
  
  
  METHODS
  A total of 144 patients with ischemic cerebrovascular disease (53 carotid endarterectomy [CEA] for carotid artery stenosis, 48 carotid artery stenting [CAS] for carotid artery stenosis, 20 bypass surgery for atherosclerotic cerebrovascular disease, 40 bypass surgery for moyamoya disease [MMD]) underwent vascular reconstruction. Patients were examined neurologically and radiologically, including computed tomography, magnetic resonance imaging, and single-photon-emission computed tomography, and then CHS was evaluated.
  
  
  RESULTS
  CHS developed in 1 (1.9%) CEA, 1 (2.1%) CAS, 1 (5.0%) bypass surgery for atherosclerotic cerebrovascular disease, and 6 (15.0%) bypass surgery for MMD. The incidence of CHS was significantly higher in patients with MMD. Aged patients and impairment of cerebrovascular reserve were correlated with CHS. Patients manifested disorientation after CEA and complained of headache after CAS. Diffuse hemispheric hyperperfusion was detected by single-photon-emission computed tomography. However, MMD patients manifested focal neurologic deficit, focal cerebral edema, and increased regional cerebral blood flow around vascular anastomosis. These patients were treated with blood pressure control and administration of free radical scavengers, and recovered without permanent deficits.
  
  
  CONCLUSIONS
  The incidence of CHS is significantly higher in patients with MMD and results in vasogenic edema visible on magnetic resonance imaging.
authors: Department of Neurosurgery, Nagasaki University School of Medicine, Nagasaki, Japan. kenkuni@net.nagasaki-u.ac.jp
authors: Kentaro
authors: K
authors: Hayashi
authors: Nobutaka
authors: N
authors: Horie
authors: Kazuhiko
authors: K
authors: Suyama
authors: Izumi
authors: I
authors: Nagata
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D002537:Intracranial Arteriosclerosis / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D002546:Ischemic Attack, Transient / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009072:Moyamoya Disease / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology*; D015607:Stents / Q000009:adverse effects*; D014656:Vascular Surgical Procedures / Q000009:adverse effects