Transient crossed cerebellar diaschisis due to cerebral hyperperfusion following surgical revascularization for moyamoya disease: case report.
Crossed cerebellar diaschisis (CCD) often occurs after ischemic or hemorrhagic stroke that damages the cortico-ponto-cerebellar pathway. However, CCD due to cerebral hyperperfusion following cerebrovascular reconstruction is rare. A 61-year-old woman presented with transient CCD due to cerebral hyperperfusion following bypass surgery for adult moyamoya disease. She developed transient weakness of the right extremities and was diagnosed with moyamoya disease. First, she underwent superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis with indirect synangiosis on the left. Postoperative course was uneventful. Subsequently, she underwent STA-MCA anastomosis with indirect synangiosis on the right. She complained of mild headache on the right, and single photon emission computed tomography (SPECT) performed on the 7th postoperative day demonstrated hyperperfusion in the right frontal and temporal lobes associated with hypoperfusion in the left cerebellum. Magnetic resonance (MR) imaging demonstrated no new lesions and MR angiography showed patent STA-MCA bypass. Subsequent SPECT showed disappearance of both hyperperfusion and CCD. This case strongly suggests that cerebral hyperperfusion after bypass surgery for moyamoya disease may cause transient CCD. Although the clinical significance is still obscure, this phenomenon indicates the cortico-ponto-cerebellar pathway is interrupted due to hyperperfusion, suggesting the development of hyperperfusion syndrome. Careful observation of cerebral hemodynamics after bypass surgery is warranted to avoid hyperperfusion-related complications.
Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan. karimasa@med.hokudai.ac.jp
Masaaki
M
Hokari
Satoshi
S
Kuroda
Yusuke
Y
Simoda
Haruto
H
Uchino
Kenji
K
Hirata
Tohru
T
Shiga
Naoki
N
Nakayama
Kiyohiro
K
Houkin
Nagara
N
Tamaki
D002526:Cerebellar Diseases / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D002531:Cerebellum / Q000098:blood supply / Q000503:physiopathology; D002548:Cerebral Revascularization / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply / Q000503:physiopathology; D006801:Humans; D006940:Hyperemia / Q000209:etiology / Q000503:physiopathology; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D009072:Moyamoya Disease / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D009434:Neural Pathways / Q000098:blood supply / Q000503:physiopathology; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011877:Radionuclide Imaging; D013702:Temporal Lobe / Q000098:blood supply / Q000503:physiopathology