DWI–MRI findings and post EC–IC bypass surgery cerebral hyperperfusion syndrome: literature review and case report

Primary modality for surgical treatment of clinically significant internal carotid artery occlusion (ICA) is considered to be application of extra-intracranial microanastomosis (EC–IC bypass). Cerebral hyperperfusion syndrome (CHS) has been not infrequent complication within early post-operation period.

OBJECTIVE:  description of clinical and investigational phenomena of DWI -positive cerebral MRI findings following application of extra-intracranial microanastomosis in patients with clinical signs of CHS in early post-surgery period.

MATERIAL AND METHODS .  Retrospective evaluation of 37 patients’ records has been performed for the period from 2015 to 2021, of the patients, who had undergone treatment in the  department of Neurosurgery of Interregional Clinical diagnostic Center with EC–IC bypass application associated with clinical signs of CHS in the early post-surgery period.

RESULTS .  Patients  with  CHS  during  early  post-surgery  period  presented  with  the  following  symptoms:  seizures, psychomotor agitation, new focal neurological deficit. Cerebral MRI was performed in 37 patients with clinical signs of CHS following EC–IC bypass. In 34 of 37 patients restricted diffusion lesions were revealed on  DWI-weighted images. All patients in the examined cohort had patent bypass confirmed with multiple diagnostic modalities including transcranial duplex scanning, multidetector CT-angiography and 3d-TOF  MRA. depending on actual DWI-positive lesions location (within concerned artery supply area) focal clinical symptoms were observed however different in the intensity.

CONCLUSION. Patients with clinical signs of CHS following EC–IC bypass application due to chronic ICA occlusion specific, however different from “classical” ischemic lesions, MRI abnormalities were revealed. however precise mechanism of their evolvement is not fully understood. Further investigations concerning CHS pathogenesis are required.

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