title: [Recurrent hyperperfusion after revascularization surgery for adult moyamoya disease: a case report].
abstract: Direct bypass surgery for moyamoya disease is quite useful for rapidly improving cerebral hemodynamics and resolving ischemic attacks but may induce hyperperfusion syndrome. In this report, we present a rare case of recurrent hyperperfusion after surgery for moyamoya disease. A 47-year-old woman developed left homonymous hemianopsia and was admitted to our hospital. Magnetic resonance(MR)imaging/angiography revealed definitive moyamoya disease presenting with acute cerebral infarction in the right temporoparietal lobe. She was treated with anti-hypertensive agents because she had severe hypertension. She successfully underwent right superficial temporal artery-middle cerebral artery double anastomosis and indirect bypass. A cerebral blood flow study just after surgery demonstrated marked hyperperfusion in the operated hemisphere. A repeat study 2 days later revealed that the hyperperfusion was dramatically improved. Subsequently, however, she developed a severe ipsilateral headache and focal seizure regardless of the blood pressure control. She complained of the headache for >2 weeks. Follow-up MRI showed a small subcortical hemorrhage in the right frontal lobe. Single-photon emission computed tomography revealed that the hyperperfusion relapsed 9 days after surgery and then gradually disappeared. This study shows that preoperative severe hypertension may induce uncontrollable hyperperfusion after direct bypass surgery for moyamoya disease.
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama.
authors.forename: Tomohide
authors.initials: T
authors.lastname: Hayashi
authors.forename: Daina
authors.initials: D
authors.lastname: Kashiwazaki
authors.forename: Naoki
authors.initials: N
authors.lastname: Akioka
authors.forename: Naoya
authors.initials: N
authors.lastname: Kuwayama
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuroda
mesh_terms: D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D002544:Cerebral Infarction / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D002548:Cerebral Revascularization / Q000379:methods; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D018810:Magnetic Resonance Angiography / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D009072:Moyamoya Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D011183:Postoperative Complications; D055502:Secondary Prevention