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• W4225378070 abstract "HomeStrokeVol. 53, No. 6Cerebral Hyperperfusion After Double Barrel Superficial Temporal Artery-Middle Cerebral Artery Bypass Free AccessCase ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCase ReportPDF/EPUBCerebral Hyperperfusion After Double Barrel Superficial Temporal Artery-Middle Cerebral Artery Bypass Ari D. Kappel, Joshua D. Bernstock and Nirav J. Patel Ari D. KappelAri D. Kappel https://orcid.org/0000-0002-6179-8461 Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA (A.D.K., J.D.B., N.J.P.). Harvard Medical School, Boston, MA (A.D.K., J.D.B., N.J.P.). Search for more papers by this author , Joshua D. BernstockJoshua D. Bernstock https://orcid.org/0000-0002-7814-3867 Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA (A.D.K., J.D.B., N.J.P.). Harvard Medical School, Boston, MA (A.D.K., J.D.B., N.J.P.). Search for more papers by this author and Nirav J. PatelNirav J. Patel Correspondence to: Nirav J. Patel, MD, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Hale Bldg, 4th Floor, 60 Fenwood Rd, Boston, MA 02115. Email E-mail Address: [email protected] https://orcid.org/0000-0003-1725-3293 Department of Neurosurgery, Brigham and Women’s Hospital, Boston, MA (A.D.K., J.D.B., N.J.P.). Harvard Medical School, Boston, MA (A.D.K., J.D.B., N.J.P.). Search for more papers by this author Originally published3 May 2022https://doi.org/10.1161/STROKEAHA.122.039227Stroke. 2022;53:e226–e227Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: May 3, 2022: Ahead of Print A 67-year-old male presented with recurrent transient ischemic attacks characterized by left facial droop and left-hand clumsiness. Magnetic resonance imaging/magnetic resonance angiography of the brain demonstrated punctate infarcts in the right hemisphere and severe right middle cerebral artery stenosis (Figure 1). He underwent craniotomy for right superficial temporal artery-middle cerebral artery double-barrel bypass and a postoperative computed tomography angiography demonstrated patency of the graft (Figure 2A).Download figureDownload PowerPointFigure 1. Preoperative imaging. A, Representative slice of the axial apparent diffusion coefficient (ADC) weighted magnetic resonance imaging (MRI) shows multiple right hemispheric punctate infarcts (arrows). B, Coronal magnetic resonance angiography (MRA) maximum intensity projections (MIPs) and computed tomography angiography (CTA) MIPs (C) demonstrate severe right middle cerebral artery (MCA) stenosis (arrowheads).Download figureDownload PowerPointFigure 2. Postoperative imaging obtain on day 5 when new symptoms developed. A, Postoperative computed tomography angiography (CTA) demonstrates patent double-barrel superficial temporal artery (STA)-middle cerebral artery (MCA) bypass crossing the craniotomy defect. B, Computed tomography perfusion (CTP) imaging on postoperative day 5 demonstrates increased cerebral blood flow (CBF) and cerebral blood volume (CBV) with shortened mean transit time (MTT) and time to peak (TTP) consistent with graft associated hyperperfusion. After extracranial-intracranial (EC-IC) bypass cerebral hyperperfusion may develop as demonstrated by these CTP findings.On postoperative day 5, he developed headaches, dysarthria, left facial droop, and hypertension with a systolic blood pressure of 170 mm Hg. Repeat computed tomography angiography with computed tomography perfusion showed hyperperfusion around the graft, and relative hypoperfusion in the remaining right hemisphere (Figure 2B). After the systolic blood pressure was treated to 130 mm Hg, the patient’s symptoms and CTP changes resolved.KEY POINTAfter extracranial-intracranial bypass cerebral hyperperfusion syndrome characterized by hypertension, headache, and focal neurological deficits may occur with classic imaging findings of increased cerebral blood flow and cerebral blood volume with shortened mean transit time and time to peak.After extracranial-intracranial bypass cerebral hyperperfusion syndrome is characterized by ipsilateral headache, focal neurological deficits, and hypertension. It is often focal and does not involve the entire hemisphere. If treated promptly symptoms should resolve.1Article InformationSources of FundingNone.Disclosures Dr Bernstock has an equity position in Avidea Technologies, Inc, which is commercializing polymer-based drug delivery technologies for immunotherapeutic applications. Dr Bernstock has an equity position in Treovir LLC, an oHSV clinical stage company and is a member of the POCKiT Diagnostics Board of Scientific Advisors. The other authors report no conflicts.FootnotesFor Sources of Funding and Disclosures, see page e227.Correspondence to: Nirav J. Patel, MD, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Hale Bldg, 4th Floor, 60 Fenwood Rd, Boston, MA 02115. Email [email protected]harvard.eduReference1. van Mook WN, Rennenberg RJ, Schurink GW, van Oostenbrugge RJ, Mess WH, Hofman PA, de Leeuw PW. Cerebral hyperperfusion syndrome.Lancet Neurol. 2005; 4:877–888. doi: 10.1016/S1474-4422(05)70251-9CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails June 2022Vol 53, Issue 6 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.122.039227PMID: 35502661 Originally publishedMay 3, 2022 Keywordsmagnetic resonance imagingangiographymiddle cerebral arteryblood pressurecraniotomyPDF download Advertisement SubjectsCerebrovascular Disease/StrokeCerebrovascular ProceduresIschemic StrokeTransient Ischemic Attack (TIA)" @default.
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