Skip to main content
SpringerLink
Log in

Hyperperfusion syndrome after aneurysm surgery: a case report

  • Case Report - Vascular
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

A 74-year-old woman exhibited sensory aphasia with abrupt blood pressure elevation 3 h after clipping of an unruptured large left middle cerebral artery aneurysm. Perfusion computed tomography and single-photon emission computed tomography demonstrated hyperperfusion in one of the distal parent artery areas. She gradually improved and was discharged without neurological deficits. Increased distal blood flow after occlusion of the large cerebral aneurysm and postischemic reperfusion after temporary occlusion of the parent artery during surgery presumably played an important role in the occurrence of this fairly rare condition associated with aneurysm surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Araki Y, Andoh H, Yamada M, Nakatani K, Andoh T, Sakai N (1999) Permissible arterial occlusion time in aneurysm surgery. Postoperative hyperperfusion caused by temporary clipping. Neurol Med Chir (Tokyo) 39:901–907

    Article  CAS  Google Scholar 

  2. Kuroki K, Taguchi H, Yukawa O (2006) Hyperperfusion syndrome after clipping of an unruptured aneurysm. Neurol Med Chir (Tokyo) 46:248–250

    Article  Google Scholar 

  3. Maruya J, Nishimaki K, Minakawa T (2011) Hyperperfusion syndrome after neck clipping of a ruptured aneurysm on a dolichoectatic middle cerebral artery. J Stroke Cerebrovasc Dis 20:260–263

    Article  PubMed  Google Scholar 

  4. Murakami H, Ibata M, Nakamura A, Ushioda T (2002) Ipsilateral hyperperfusion after neck clipping of a giant internal carotid artery aneurysm. J Neurosurg 97:1233–1236

    Article  PubMed  Google Scholar 

  5. Schoser BGH, Heesen C, Eckert B, Thie A (1997) Cerebral hyperperfusion injury after percutaneous transluminal angioplasty of extracranial arteries. J Neurol 244:101–104

    Article  CAS  PubMed  Google Scholar 

  6. Sugino T, Ohtaki M, Wanibuchi M, Kin S, Houkin K (2010) Hyperperfusion syndrome after clipping an unruptured cerebral aneurysm. Neurol Med Chir (Tokyo) 50:306–309

    Article  Google Scholar 

Download references

Acknowledgments

This study was supported in part by JSPS KAKENHI, grant numbers 25462235 and 26461278.

Patient consent

The patient/next of kin/guardian has consented to the submission of the case report for submission to the journal.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Author information

Authors and Affiliations

  1. Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan

    Tomomichi Kayahara, Ririko Takeda, Yuichiro Kikkawa, Yushiro Take & Hiroki Kurita

Authors
  1. Tomomichi Kayahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ririko Takeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuichiro Kikkawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yushiro Take
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroki Kurita
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tomomichi Kayahara.

Additional information

Comments

Very well written case report describing a case with transient hyperperfusion syndrome after elective surgery for a large MCA bifurcation aneurysm. The authors describe the possible mechanisms, including temporary occlusion of 10 min in total divided into three rounds, but their main hypothesis is that aneurysm occlusion led to an increase in flow through the inferior M2 trunk and hence a hyper perfusion syndrome in the angular area. This is substantiated by their intro flow measurements. Intraoperative Doppler ultrasound flowmetry revealed that the blood flow of the M2 segments distal to the aneurysm before and after clipping were 75 and 50 ml/min (superior trunk) and 22 and 48 ml/min (inferior trunk), respectively. In my personal experience, I have had similar cases, but never performed this thorough intro and post investigations, something I commend the authors for. I use temporary clipping in the vast majority of aneurysm cases and have never seen hyperperfusion syndrome postop unless there was a large or giant aneurysm, so I believe that the hyper perfusion is secondary to clipping of the aneurysm, thereby leading to reduced attenuation of flow in the M2 branches.

Torstein Meling

Oslo, Norway

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kayahara, T., Takeda, R., Kikkawa, Y. et al. Hyperperfusion syndrome after aneurysm surgery: a case report. Acta Neurochir 157, 1855–1857 (2015). https://doi.org/10.1007/s00701-015-2567-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-015-2567-5

Keywords

Search

Navigation