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Cerebral Hyperperfusion Syndrome After a Burr Hole Drainage Surgery for Chronic Subdural Hematoma
Takaki Omura1, Yuta Fukushima1, Gakushi Yoshikawa2
1Department of Neurosurgery, Showa General Hospital, Kodaira, Tokyo, Japan; Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
Insights
Cerebral hyperperfusion syndrome (CHS) is a rare but severe complication after chronic subdural hematoma (CSDH) drainage surgery. Early detection using MRI techniques like FLAIR and ASL imaging is crucial for prompt management and improved patient outcomes.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Chronic subdural hematoma (CSDH) drainage surgery typically has a good prognosis.
- Severe complications can still occur, though cerebral hyperperfusion syndrome (CHS) is rare after CSDH surgery compared to carotid procedures.
Purpose of the Study:
- To report a case of CHS following CSDH drainage surgery.
- To highlight the utility of specific MRI techniques in diagnosing CHS post-CSDH surgery.
Main Methods:
- A case report of an 82-year-old woman experiencing neurological symptoms post-CSDH burr hole drainage.
- Utilized magnetic resonance fluid-attenuated inversion recovery (FLAIR) imaging to detect subcortical low intensity.
- Employed arterial spin labeling (ASL) magnetic resonance perfusion imaging to assess cerebral blood flow.
- Managed symptoms with propofol and blood pressure control.
Main Results:
- The patient presented with hemiparesis, dysarthria, altered consciousness, and status epilepticus after surgery.
- FLAIR imaging revealed diffuse subcortical low intensity in the ipsilesional hemisphere.
- ASL imaging demonstrated increased cerebral blood flow in the affected hemisphere.
- Symptoms improved with medical management.
Conclusions:
- CHS can lead to severe complications after CSDH drainage.
- FLAIR imaging is valuable for early CHS detection in CSDH patients.
- ASL imaging provides an effective, minimally-invasive method for confirming CHS diagnosis.
Background:
Although chronic subdural hematoma (CSDH) has a good prognosis after classical minimally-invasive drainage surgery, severe complications still occur at a substantial rate. Cerebral hyperperfusion syndrome (CHS), which is a common severe complication after carotid endarterectomy or carotid artery stenting for cervical carotid artery stenosis, is rare after drainage surgery for a CSDH.
Case Description:
We describe the case of an 82-year-old woman who presented with ipsilesional symptoms including contralateral hemiparesis and dysarthria, progressively worsening consciousness, and status epilepticus after a burr hole drainage surgery for CSDH. Magnetic resonance fluid-attenuated inversion recovery imaging showed diffuse subcortical low intensity in the ipsilesional hemisphere almost simultaneously with the appearance of the symptoms. Arterial spin labeling magnetic resonance perfusion imaging showed the abnormal increase of cerebral blood flow in the hemisphere. Continuous propofol administration and blood pressure management improved the symptoms.
Conclusions:
CHS can cause severe postoperative complications after drainage surgery for CSDH. Subcortical low-intensity fluid-attenuated inversion recovery imaging is a useful investigation for early detection of CHS in CSDH, and arterial spin labeling imaging is an effective minimally-invasive modality for confirming the diagnosis.
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