Post-ischemic hyperperfusion after clipping of a ruptured internal carotid-posterior communicating artery aneurysm under suction decompression
A 64-year-old woman presenting with subarachnoid hemorrhage (World Federation of Neurosurgeons grade IV) from the rupture of a right large internal carotid-posterior communicating artery aneurysm suffered neuronal damage associated with post-ischemic hyperperfusion after neck clipping of the aneurys...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2014-09-01
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| Series: | Interdisciplinary Neurosurgery |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214751914000358 |
| Summary: | A 64-year-old woman presenting with subarachnoid hemorrhage (World Federation of Neurosurgeons grade IV) from the rupture of a right large internal carotid-posterior communicating artery aneurysm suffered neuronal damage associated with post-ischemic hyperperfusion after neck clipping of the aneurysm under suction decompression. She did not completely recover consciousness after the operation. Diffusion-weighted imaging (DWI) performed on the first postoperative day showed subtle cortical hyperintensity in the parietal lobe. Arterial spin-labeling (ASL) and 123I-iodoamphetamine (123I-IMP) single photon emission computed tomography (SPECT) demonstrated hyperperfusion in the right temporo-parietal lobes. Delayed 123I-iomazenil (123I-IMZ) SPECT images showed a reduced IMZ uptake in the right temporo-parietal lobe corresponding to the hyperperfusion area on ASL images. DWI repeated on postoperative day 3 revealed progression of a hyperintensity lesion in the right parietal lobe. Blood pressure control and the use of a free radical scavenger relieved her symptoms. One month later, the area of reduced IMZ uptake was further expanded. Our findings suggest that post-ischemic hyperperfusion after suction decompression may result in neuronal damage demonstrated on 123I-IMZ SPECT images. |
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| ISSN: | 2214-7519 |