내경동맥 스텐트 삽입술 후 발생한 과관류 증후군 1예 : 18FDG-Brain Fusion PET CT 경험
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The hyperperfusion syndrome is a rare complication after carotid endarterectomy or carotid stenting. The clinical manifestations are headache, seizures, brain edema, focal neurologic deficits and intracranial hemorrhage due to the loss of autoregulation of cerebral vasculature. We report the first case of 18-fluorodeoxyglucose (18FGD) brain fusion positron emission tomography (PET) CT findings of hyperperfusion syndrome after stenting. A 74- year-old, normotensive man was admitted one day after left side hemiparesis. Brain MRI revealed recent infarctions in the right middle cerebral artery (MCA) territory. Cerebral angiography confirmed a significant stenosis of the right internal carotid artery. Percutaneous transluminal stenting was performed successfully. Five minutes after the procedure, he suddenly showed right gaze preference, dysarthria and aggravation of the left side weakness. Brain CT and MRI showed diffuse contrast enhancements in the right hemisphere, without any acute hemorrhage or infarctions, meanwhile 1 8FDG-Brain Fusion PET CT showed asymmetrically decreased glucose metabolism. This case suggests that the hyperperfusion syndrome induces metabolic deterioration of the affected brain. (Korean Journal of Stroke 2005;7(2): 232~236)
Abstract
The hyperperfusion syndrome is a rare complication after carotid endarterectomy or carotid stenting. The clinical manifestations are headache, seizures, brain edema, focal neurologic deficits and intracranial hemorrhage due to the loss of autoregulation of cerebral vasculature. We report the first case of 18-fluorodeoxyglucose (18FGD) brain fusion positron emission tomography (PET) CT findings of hyperperfusion syndrome after stenting. A 74- year-old, normotensive man was admitted one day after left side hemiparesis. Brain MRI revealed recent infarctions in the right middle cerebral artery (MCA) territory. Cerebral angiography confirmed a significant stenosis of the right internal carotid artery. Percutaneous transluminal stenting was performed successfully. Five minutes after the procedure, he suddenly showed right gaze preference, dysarthria and aggravation of the left side weakness. Brain CT and MRI showed diffuse contrast enhancements in the right hemisphere, without any acute hemorrhage or infarctions, meanwhile 1 8FDG-Brain Fusion PET CT showed asymmetrically decreased glucose metabolism. This case suggests that the hyperperfusion syndrome induces metabolic deterioration of the affected brain. (Korean Journal of Stroke 2005;7(2): 232~236)