Slowly progressive neuronal death associated with postischemic hyperperfusion in cortical laminar necrosis after high-flow bypass for a carotid intracavernous aneurysm: Case report

Koji Iihara, Masakazu Okawa, Tomohito Hishikawa, Naoaki Yamada, Kazuhito Fukushima, Hidehiro Iida, Susumu Miyamoto

Research output: Contribution to journalArticle

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Abstract

The authors report a rare case of slowly progressive neuronal death associated with postischemic hyperperfusion in cortical laminar necrosis after radial artery/external carotid artery-middle cerebral artery bypass graft surgery for an intracavernous carotid artery aneurysm. Under barbiturate protection, a 69-year-old man underwent high-flow bypass surgery combined with carotid artery sacrifice for a symptomatic intracavernous aneurysm. The patient became restless postoperatively, and this restlessness peaked on postoperative Day (POD) 7. Diffusion-weighted and FLAIR MR images obtained on PODs 1 and 7 revealed subtle cortical hyperintensity in the temporal cortex subjected to temporary occlusion. On POD 13, 123I-iomazenil (123I-IMZ) SPECT clearly showed increased distribution on the early image and mildly decreased binding on the delayed image with count ratios of the affected-unaffected corresponding regions of interest of 1.23 and 0.84, respectively, suggesting postischemic hyperperfusion. This was consistent with the finding on 123I-iodoamphetamine SPECT. Of note, neuronal density in the affected cortex on the delayed 123I-IMZ image further decreased to the affected/unaffected ratio of 0.44 on POD 55 during the subacute stage when characteristic cortical hyperintensity on T1-weighted MR imaging, typical of cortical laminar necrosis, was emerging. The affected cortex showed marked atrophy 8 months after the operation despite complete neurological recovery. This report illustrates, for the first time, dynamic neuroradiological correlations between slowly progressive neuronal death shown by 123I-IMZ SPECT and cortical laminar necrosis on MR imaging in human stroke.

Original languageEnglish
Pages (from-to)1254-1259
Number of pages6
JournalJournal of Neurosurgery
Volume112
Issue number6
DOIs
Publication statusPublished - Jun 2010
Externally publishedYes

Fingerprint

Single-Photon Emission-Computed Tomography
Aneurysm
Necrosis
Carotid Arteries
External Carotid Artery
Psychomotor Agitation
Radial Artery
Middle Cerebral Artery
Temporal Lobe
Atrophy
Stroke
Transplants
iomazenil

Keywords

  • Bypass
  • Delayed neuronal death
  • Iomazenil
  • Laminar necrosis
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Slowly progressive neuronal death associated with postischemic hyperperfusion in cortical laminar necrosis after high-flow bypass for a carotid intracavernous aneurysm : Case report. / Iihara, Koji; Okawa, Masakazu; Hishikawa, Tomohito; Yamada, Naoaki; Fukushima, Kazuhito; Iida, Hidehiro; Miyamoto, Susumu.

In: Journal of Neurosurgery, Vol. 112, No. 6, 06.2010, p. 1254-1259.

Research output: Contribution to journalArticle

Iihara, Koji ; Okawa, Masakazu ; Hishikawa, Tomohito ; Yamada, Naoaki ; Fukushima, Kazuhito ; Iida, Hidehiro ; Miyamoto, Susumu. / Slowly progressive neuronal death associated with postischemic hyperperfusion in cortical laminar necrosis after high-flow bypass for a carotid intracavernous aneurysm : Case report. In: Journal of Neurosurgery. 2010 ; Vol. 112, No. 6. pp. 1254-1259.
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