title: Chronic brain hypoperfusion due to multi-vessel extracranial atherosclerotic disease: a potentially reversible cause of cognitive impairment.
abstract: A 62-year-old patient presented with persistent cognitive deficits 3 months after a right temporal ischemic stroke due to ipsilateral carotid occlusion. Work-up disclosed hemodynamically significant contralateral carotid artery stenosis and left subclavian steal phenomenon. Brain SPECT imaging revealed bihemispheric chronic brain hypoperfusion that substantially improved on repeat imaging when the subclavian steal was temporarily diminished by inflating a cuff around the left arm. Carotid endarterectomy of the asymptomatic carotid stenosis substantially ameliorated bihemispheric brain perfusion and reversed cognitive impairment. This case highlights that multi-vessel, extracranial atherosclerotic disease may cause chronic diffuse brain hypoperfusion that can be associated with cognitive impairment.
authors: Stroke Unit, Department of Neurology, Brugmann University Hospital, Brussels, Belgium.
authors: Apostolos
authors: A
authors: Safouris
authors: Nuclear Medicine Department, Brugmann University Hospital, Brussels, Belgium.
authors: Anne-Sophie
authors: AS
authors: Hambye
authors: Stroke Unit, Department of Neurology, Brugmann University Hospital, Brussels, Belgium.
authors: Claudine
authors: C
authors: Sculier
authors: Second Department of Neurology, University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece.
authors: Sokratis G
authors: SG
authors: Papageorgiou
authors: Third Department of Surgery, School of Medicine, University of Athens, Athens, Greece.
authors: Spyros N
authors: SN
authors: Vasdekis
authors: Stroke Unit, Department of Neurology, Brugmann University Hospital, Brussels, Belgium.
authors: Marie-Dominique
authors: MD
authors: Gazagnes
authors: Second Department of Neurology, University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic.
authors: Georgios
authors: G
authors: Tsivgoulis
mesh_terms: D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001921:Brain / Q000000981:diagnostic imaging / Q000503:physiopathology; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D002340:Carotid Artery Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D002560:Cerebrovascular Circulation / Q000502:physiology; D002908:Chronic Disease; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
keywords: Asymptomatic carotid stenosis; SPECT; carotid endarterectomy; chronic brain hypoperfusion; subclavian steal; transcranial Doppler