| Postcarotid endarterectomy hyperperfusion or reperfusion syndrome. | |
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MedLine Citation:
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PMID: 15576656 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Hyperperfusion syndrome (HS) after carotid endarterectomy (CEA) has been related to impaired cerebrovascular autoregulation in a chronically hypoperfused hemisphere. Our aim was to provide new insight into the pathophysiology of the HS using magnetic resonance imaging (MRI) studies with diffusion-weighted imaging (DWI) and perfusion-weighted imaging (PWI). METHODS: Five out of 388 consecutive patients presented 2 to 7 days after CEA, partial seizures (n=5), focal deficits (n=5), and intracerebral hemorrhage (n=3). In 4 patients, using sequential examinations, we identified vasogenic or cytotoxic edema by DWI; we assessed relative interhemispheric difference (RID) of cerebral blood flow (CBF) by PWI; and we measured middle cerebral artery mean flow velocities (MCA Vm) by transcranial Doppler (TCD). RESULTS: None of the patients presented pathological DWI hyperintensities, consistent with the absence of acute ischemia or cytotoxic edema. In 2 patients, we found an MRI pattern of reversible vasogenic edema similar to that observed in the posterior leukoencephalopathy syndrome. Middle cerebral artery (MCA) mean flow velocities (Vm) were not abnormally increased at any time. PWI documented a 20% to 44% RID of CBF in favor of the ipsilateral to CEA hemisphere. CONCLUSIONS: HS can occur in the presence of moderate relative hyperperfusion of the ipsilateral hemisphere. MCA Vm values may not accurately reflect RID of CBF over the cortical convexity. We suggest that the hemodynamic pathogenetic mechanisms of the HS are more complicated than hitherto believed and that they may be more accurately described by the term "reperfusion syndrome." |
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Authors:
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Theodoros Karapanayiotides; Reto Meuli; Gerald Devuyst; Bartlomiej Piechowski-Jozwiak; Annelise Dewarrat; Patrick Ruchat; Ludwig Von Segesser; Julien Bogousslavsky |
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Publication Detail:
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Type: Case Reports; Journal Article; Research Support, Non-U.S. Gov't Date: 2004-12-02 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 36 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2005 Jan |
Date Detail:
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Created Date: 2004-12-24 Completed Date: 2005-09-01 Revised Date: 2007-05-23 |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 21-6 Citation Subset: IM |
Affiliation:
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Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerlandeece. theoneu@otenet.gr |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cerebral Hemorrhage / etiology Cerebrovascular Circulation Cerebrovascular Disorders / diagnosis, etiology* Diffusion Magnetic Resonance Imaging Endarterectomy, Carotid* Female Humans Magnetic Resonance Angiography Male Reperfusion Injury / diagnosis, etiology* Seizures / etiology Syndrome Tomography, X-Ray Computed Ultrasonography, Doppler, Transcranial |
| Comments/Corrections | |
Comment In:
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Perspect Vasc Surg Endovasc Ther. 2005 Dec;17(4):381-2
[PMID:
16389439
]
Stroke. 2005 Apr;36(4):706-7; author reply 706-7 [PMID: 15800246 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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