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Hyperperfusion Syndrome after Stent/Coiling of a Ruptured Carotid Bifurcation Aneurysm

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Abstract

The authors report a syndrome of regional, symptomatic cerebral hyperperfusion, and edema mimicking infarction in a 54-year-old woman following coiling of a ruptured right carotid bifurcation aneurysm and stenting of the right middle cerebral artery. The patient presented with a Hunt and Hess grade III subarachnoid hemorrhage 7 days after developing thunderclap headache. She underwent successful coiling under general anesthesia of the 1.6 × 1.5 × 1.6 cm aneurysm, but immediately after the coil was placed occlusion of the proximal M1 segment was developed. This occlusion was stented after ~5-min delay, and flow restored without angiographic evidence of distal emboli. Following the procedure, she was extubated and noted to have left hemiparesis, neglect, and mutism without a CT correlate. Cerebral infarction was suspected, but urgent repeat angiography demonstrated patent cerebral vasculature. On the following day, symptoms persisted, and non-contrast head CT now showed cerebral edema localized to the right middle cerebral artery territory mimicking subacute infarction. CT perfusion imaging and angiography showed a widely patent MCA circulation, and suggested a regional hyperperfusion syndrome. The blood pressure was incrementally lowered, with rapid and sustained neurological improvement. Hyperperfusion events following aneurysm repair and related circumstances are reviewed.

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Authors and Affiliations

  1. Departments of Surgery (RDE, RDM), Critical Care Medicine (DBS), Maine Medical Center, 49 Spring Street, Scarborough, Portland, ME, 04074, USA

    Robert D. Ecker, Richard D. Murray & David B. Seder

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  1. Robert D. Ecker
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  2. Richard D. Murray
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  3. David B. Seder
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Correspondence to Robert D. Ecker.

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Ecker, R.D., Murray, R.D. & Seder, D.B. Hyperperfusion Syndrome after Stent/Coiling of a Ruptured Carotid Bifurcation Aneurysm. Neurocrit Care 18, 54–58 (2013). https://doi.org/10.1007/s12028-012-9733-x

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  • DOI: https://doi.org/10.1007/s12028-012-9733-x

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