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AJNR - American Journal of Neuroradiology

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Hyperperfusion Syndrome with Hemorrhage after Angioplasty for Middle Cerebral Artery Stenosis

Amon Y. Liu^a, Huy M. Do^a, Gregory W. Albers^a, Jaime R. Lopez^a, Gary K. Steinberg^a and Michael P. Marks^a

^a From the Department of Radiology (A.Y.L., H.M.D., M.P.M.), Stanford Stroke Center (A.Y.L., H.M.D., G.W.A., J.R.L., G.K.S., M.P.M.), Department of Neurology (G.W.A., J.R.L.), and Department of Neurosurgery (G.K.S.), Stanford University School of Medicine, Stanford, CA.

View larger version (86K): [in a new window]   FIG 1. Noncontrast head CT. Two contiguous slices at the level of the basal ganglia 6 days prior to left M2 segment balloon angioplasty demonstrate left frontal and subinsular small vessel disease.FIG 2. Left ICA angiogram (anterior projection) at the time of initial evaluation reveals a severe, approximately 95%, focal stenosis of the proximal M2 segment (arrow) of the left MCA.FIG 3. Xe-CT with axial CT and blood flow map images on two contiguous slices before (A) and after (B) acetazolamide challenge 1 day prior to balloon angioplasty. Loss of cerebrovascular autoregulation is most notable in the left frontal lobe, as demonstrated by paradoxically low cerebral blood flow after acetazolamide administration. Note arrows between areas on the postacetazolamide scans. The color coding scale is defined in units of cc/100 g tissue/min

View larger version (71K): [in a new window]   FIG 4. Left ICA angiogram (anterior projection) following left M2 segment balloon angioplasty (arrow). The focal stenosis was reduced to approximately 55%, with no evidence of vessel dissection, perforation, or thrombus formation.FIG 5. Head CT 2 hours following angioplasty, at the time of acute-onset right hemiparesis and aphasia. A massive left frontal intraparenchymal hemorrhage is seen with subfalcine herniation