title: Hyperperfusion syndrome after stent/coiling of a ruptured carotid bifurcation aneurysm.
abstract: The authors report a syndrome of regional, symptomatic cerebral hyperperfusion, and edema mimicking infarction in a 54-year-old woman following coiling of a ruptured right carotid bifurcation aneurysm and stenting of the right middle cerebral artery. The patient presented with a Hunt and Hess grade III subarachnoid hemorrhage 7 days after developing thunderclap headache. She underwent successful coiling under general anesthesia of the 1.6 × 1.5 × 1.6 cm aneurysm, but immediately after the coil was placed occlusion of the proximal M1 segment was developed. This occlusion was stented after ~5-min delay, and flow restored without angiographic evidence of distal emboli. Following the procedure, she was extubated and noted to have left hemiparesis, neglect, and mutism without a CT correlate. Cerebral infarction was suspected, but urgent repeat angiography demonstrated patent cerebral vasculature. On the following day, symptoms persisted, and non-contrast head CT now showed cerebral edema localized to the right middle cerebral artery territory mimicking subacute infarction. CT perfusion imaging and angiography showed a widely patent MCA circulation, and suggested a regional hyperperfusion syndrome. The blood pressure was incrementally lowered, with rapid and sustained neurological improvement. Hyperperfusion events following aneurysm repair and related circumstances are reviewed.
authors.affiliation: Departments of Surgery (RDE, RDM), Critical Care Medicine (DBS), Maine Medical Center, Scarborough, Portland, ME 04074, USA. eckerr@mmc.org
authors.forename: Robert D
authors.initials: RD
authors.lastname: Ecker
authors.forename: Richard D
authors.initials: RD
authors.lastname: Murray
authors.forename: David B
authors.initials: DB
authors.lastname: Seder
mesh_terms: D017542:Aneurysm, Ruptured / Q000601:surgery*; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology*; D002340:Carotid Artery Diseases / Q000601:surgery*; D002533:Cerebral Angiography; D054022:Cerebrum / Q000098:blood supply*; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery; D015427:Reperfusion Injury / Q000000981:diagnostic imaging / Q000209:etiology*; D015607:Stents; D013577:Syndrome; D014057:Tomography, X-Ray Computed