J Korean Soc Geriatr Neurosurg > Volume 16(1); 2020 > Article
Journal of Korean Society of Geriatric Neurosurgery 2020;16(1):20-27.
DOI: https://doi.org/10.51638/jksgn.20.00143    Published online September 30, 2020.
The Usefulness of Magnetic Resonance Fluid Attenuation Inversion Recovery Image for Early Diagnosis of Cerebral Hyperperfusion Syndrome
Jeong Mo Shin, Ik Seong Park
Department of Neurosurgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Korea
Correspondence:  Ik Seong Park, Tel: +82-32-340-7212, Fax: +82-32-340-7391, 
Email: ispahk@gmail.com
Abstract
Objective
Cerebral hyperperfusion syndrome (CHS) is a post-surgical hemodynamic change that requires accurate diagnosis and comprehensive care. Diagnostic criteria are hyperperfusion state without acute infarction or hemorrhage. However, obtaining the exact hyperemia images is difficult; thus, diagnosis is suggested when any infarction or post-surgical hematomas are excluded. In the present study, magnetic resonance image (MRI) findings indicative of CHS pathophysiology were investigated.
Methods
A retrospective study was performed of patients who underwent superficial temporal to middle cerebral artery anastomosis due to atherosclerotic steno-occlusive disease or moyamoya disease. All patients underwent hemodynamic evaluations, including perfusion MRI, single-photon emission computed tomography (SPECT), and digital subtraction angiography preoperatively and postoperatively. CHS was defined based on the symptoms and radiologic findings.
Results
Among the 172 hemispheres investigated in the present study, CHS occurred in 16 patients (9.3%). Symptoms of CHS were seizure, motor weakness, and aphasia. Median symptom onset time was 2.6 days (1-8 days). Brain fluid-attenuated inversion recovery (FLAIR) MRI revealed geographic shape high signal intensity area in the white matter in all patients. Apparent diffusion coefficient (ADC) map showed low signal intensity in the same area, indicating interstitial edema. Perfusion MRI or SPECT images showed variable results for defining CHS.
Conclusion
MR FLAIR image combined with the ADC map is a useful diagnostic tool for CHS in the early stage and can aid in the early treatment of CHS and prevent worsening of symptoms.
Key Words: Cerebral bypass surgery, Cerebral hyperperfusion syndrome, Ischemic cerebrovascular disease, Revascularization
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