[Severe cerebral haemodynamic impairment treated with bypass surgery]

Cerebral hypoperfusion due to steno-occlusive large artery disease poses a diagnostic challenge. This is a case report of a 72-year-old woman, presenting with recurring paroxysmal right-sided hemiparesis, dysphasia and occasionally limb-shaking transient ischaemic attacks, especially during orthostatic challenge. The condition was initially misdiagnosed as focal epilepsy. A workup revealed a left-sided carotid artery occlusion and a haemodynamic failure in the carotid distribution, seen on a 15O-H2O PET acetazolamid scan. The patient was successfully treated with an extracranial-intracranial bypass surgery.