Ultra early transient brain swelling following brief intraoperative ischaemia-reperfusion

We describe a 50-year-old patient who developed acute transient hemispheric cerebral swelling, documented by computed tomography, following a temporary constriction (20 min) of the middle cerebral artery branches due to clipping of an aneurysm. Reporting of this postischaemic phenomenon has been limited and its mechanism and treatment remain unclear. A possible underlying process could be a postischaemic reactive vasodilatation leading to congestive hyperaemia. Hyperventilation and mannitol seem to be an effective treatment of this essentially 'benign' cerebral swelling. Copyright 1999 Harcourt Publishers Ltd.