Nagashima Hideaki, Miwa Tomoru, Horiguchi Takashi, Tomio Ryosuke, Nakagawa Yu, Yoshida Kazunari
Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan.
Department of Neurosurgery, School of Medicine, Keio University, Tokyo, Japan.
J Stroke Cerebrovasc Dis. 2018 May;27(5):1425-1430. doi: 10.1016/j.jstrokecerebrovasdis.2017.11.024. Epub 2018 Jan 17.
Cerebral vasospasm is an uncontrollable and sometimes fatal complication occurring after subarachnoid hemorrhage. However, cerebral hyperperfusion syndrome is a rare complication after subarachnoid hemorrhage. Although plain computed tomography of cerebral hyperperfusion syndrome looks similar to cerebral infarction induced by cerebral vasospasm, they should be distinguished from each other because they require completely different treatments.
A 65-year-old man complained of severe headache and vomiting. A computed tomography scan of his head showed subarachnoid hemorrhage with acute hydrocephalus caused by intraventricular hematoma and aneurysm of the left middle cerebral artery. After endoscopic irrigation of the ventricular hematoma to decrease the intracranial pressure, we performed neck clipping for the ruptured aneurysm. We used a temporary clip to the proximal M1 segment twice for a total of 15 minutes. Five days after the clipping, a computed tomography scan of the patient's head showed a large low-density area in the left cerebral hemisphere. Although cerebral infarction caused by cerebral vasospasm was suspected, his perfusion computed tomography demonstrated a state of hyperperfusion corresponding to the low-density area. We started treatment to prevent vasodilation and excessive cerebral blood flow instead of treatment for cerebral vasospasm. After changing the treatment, the patient's symptoms gradually improved, and his perfusion computed tomography (8 days after surgery) showed no excessive increased blood flow.
We present a case of cerebral hyperperfusion syndrome and its successful treatment, distinct from that of cerebral vasospasm, after ruptured aneurysm clipping. In addition, we discuss the mechanism of this rare syndrome based on previous reports.
脑血管痉挛是蛛网膜下腔出血后发生的一种难以控制且有时会致命的并发症。然而，脑过度灌注综合征是蛛网膜下腔出血后一种罕见的并发症。尽管脑过度灌注综合征的普通计算机断层扫描看起来与脑血管痉挛所致脑梗死相似，但由于它们需要完全不同的治疗方法，所以应相互区分。
一名65岁男性主诉严重头痛和呕吐。其头部计算机断层扫描显示蛛网膜下腔出血，伴有因脑室内血肿和左大脑中动脉瘤导致的急性脑积水。在内镜冲洗脑室内血肿以降低颅内压后，我们对破裂的动脉瘤进行了颈部夹闭术。我们两次使用临时夹夹闭M1段近端，共持续15分钟。夹闭术后5天，患者头部计算机断层扫描显示左大脑半球有一大片低密度区。尽管怀疑是脑血管痉挛导致的脑梗死，但其灌注计算机断层扫描显示对应低密度区的脑过度灌注状态。我们开始采取预防血管扩张和脑血流过度的治疗措施，而非针对脑血管痉挛的治疗。改变治疗方法后，患者症状逐渐改善，其灌注计算机断层扫描（术后8天）显示血流未过度增加。
我们报告了一例动脉瘤夹闭术后与脑血管痉挛不同的脑过度灌注综合征病例及其成功治疗。此外，我们根据既往报道讨论了这种罕见综合征的发病机制。
