Zhang Wensheng, Xing Weifang, Zhong Xiaojing, Zhu Minzhen, He Jinzhao
Department of Neurology, Heyuan People's Hospital, Guangdong Provincial People's Hospital Heyuan Hospital, Guangdong Province, 517000, China.
Heliyon. 2023 Jun 1;9(6):e16903. doi: 10.1016/j.heliyon.2023.e16903. eCollection 2023 Jun.
There are currently no published report of hyperperfusion syndrome in the non responsible vascular area after mechanical thrombectomy for acute cerebral infarction with large vessel occlusion. Here, we report a case of hyperperfusion syndrome in the blood supply area of the right middle cerebral artery after mechanical thrombectomy for acute cerebral infarction after vertebral artery occlusion.
A 21-year-old woman developed left vertebral artery occlusion, for which she received mechanical thrombectomy and successful recanalization of her occluded cerebral vessel. Subsequently, the patient became extremely agitated, with high blood pressure and headache.
Two hours after the operation, bedside transcranial Doppler ultrasound examination found that the cerebral blood flow velocity of the M1 segment of the right middle cerebral artery was more than twice that of the left middle cerebral artery. Combined with the symptoms, signs and examination results of the patient, hyperperfusion syndrome in the blood supply area of the right middle cerebral artery was considered.
The patient was administered sedation, and her pressure and ventricular rate were strictly controlled. She was no longer agitated, and her headache was significantly relieved at 36 hours after the operation.
On the 5th day after the operation, the blood flow velocity of her right middle cerebral artery decreased to normal level, and the patient recovered well.
In this case, after mechanical thrombectomy, such patients with acute posterior circulation cerebral infarction can experience hyperperfusion syndrome in the non responsible vascular area of the anterior circulation. Bedside transcranial Doppler cerebral blood flow examination can identify the hyperperfusion state of cerebral vessels in a timely manner and effectively guide treatment.
目前尚无关于急性大脑中动脉闭塞性脑梗死机械取栓术后非责任血管区域发生高灌注综合征的报道。在此，我们报告1例椎动脉闭塞后急性脑梗死机械取栓术后大脑中动脉供血区发生高灌注综合征的病例。
一名21岁女性发生左椎动脉闭塞，接受了机械取栓术，闭塞脑血管成功再通。随后，患者变得极度烦躁，伴有高血压和头痛。
术后2小时，床旁经颅多普勒超声检查发现右侧大脑中动脉M1段脑血流速度是左侧大脑中动脉的两倍多。结合患者的症状、体征及检查结果，考虑为右侧大脑中动脉供血区高灌注综合征。
给予患者镇静治疗，并严格控制其血压和心室率。患者不再烦躁，术后36小时头痛明显缓解。
术后第5天，患者右侧大脑中动脉血流速度降至正常水平，恢复良好。
在该病例中，急性后循环脑梗死患者机械取栓术后可在前循环非责任血管区域发生高灌注综合征。床旁经颅多普勒脑血流检查可及时发现脑血管高灌注状态并有效指导治疗。
