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Pure vasogenic edema caused by cerebral hyperperfusion after superficial temporal artery to middle cerebral artery

Jouji Kokuzawa1, Yasuhiko Kaku, Takatoshi Watarai

  • 1Department of Neurosurgery, Asahi University Murakami Memorial Hospital, Gifu, Japan. schoolschool2@yahoo.co.jp

Neurologia Medico-Chirurgica
|March 27, 2010
PubMed

Insights

Cerebral hyperperfusion syndrome occurred in a patient after superficial temporal artery to middle cerebral artery bypass surgery. Prompt treatment with medication and blood pressure management resolved the brain edema and symptoms.

Area of Science:

  • Neurosurgery
  • Neurology
  • Radiology

Background:

  • Superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis is a surgical procedure to restore blood flow to the brain.
  • Cerebral hyperperfusion syndrome (CHS) is a rare but serious complication characterized by excessive blood flow to the brain.

Observation:

  • A 63-year-old patient developed transient aphasia and seizures 3-4 days post-STA-MCA anastomosis.
  • Diffusion-weighted magnetic resonance (MR) imaging showed a focal lesion at the anastomosis site with increased cerebral blood flow, indicative of vasogenic edema.

Findings:

  • The observed lesion was diagnosed as pure vasogenic edema resulting from cerebral hyperperfusion.
  • Intravenous free radical scavengers and blood pressure reduction with nicardipine improved the patient's neurological symptoms and brain edema.

Implications:

  • This case highlights that cerebral hyperperfusion syndrome can occur after STA-MCA anastomosis, not just other cerebrovascular procedures.
  • Early recognition and management, including medical therapy and blood pressure control, are crucial for favorable outcomes in patients experiencing CHS post-bypass surgery.

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