Cerebral Hyperperfusion After Hypoxic Brain Injury Secondary to Aspiration

Hypoxic-ischemic brain injury, caused by inadequate oxygenation of the brain, may present as focal neurological deficits and can be associated with postischemic hyperperfusion of the affected tissue. An 84-year-old female patient was transferred to the hospital from a rehabilitation center with shortness of breath. One week prior, the patient aspirated food and was admitted to another facility, where this became complicated by altered mental status, catatonia, and left-sided weakness. Neuroimaging was negative, and she was discharged to a rehabilitation center. Upon arrival at the center, she developed shortness of breath that prompted her to come to our facility. On examination, she exhibited left-sided focal neurological deficits, stupor, and disorientation. Non-contrast brain CT revealed no acute abnormalities. However, CT perfusion imaging revealed increased cerebral blood flow and decreased mean transit time in the right hemisphere compared to the left. These imaging findings, in conjunction with her clinical presentation, are consistent with postischemic hyperperfusion secondary to hypoxic brain injury.