Prolonged Cerebral Hyperperfusion and Subcortical Low Intensity on Fluid Attenuated Inversion Recovery Images: Unusual Manifestation after Removal of Organized Chronic Subdural Hematoma.

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Prolonged Cerebral Hyperperfusion and Subcortical Low Intensity on Fluid Attenuated Inversion Recovery Images: Unusual Manifestation after Removal of Organized Chronic Subdural Hematoma.

World Neurosurg. 2017 Mar 27;:

Authors: Tanioka S, Sato Y, Tsuda K, Niwa S, Suzuki H

Abstract
BACKGROUND: Cerebral hyperperfusion sometimes occurs after removal of chronic subdural hematoma (CSH) and usually resolves within a few days without any symptoms. Subcortical low intensity (SCLI) on fluid attenuated inversion recovery (FLAIR) magnetic resonance images is rare and has been reported in some diseases other than CSH. The authors describe a case of organized CSH who suffered prolonged neurologic deterioration, SCLI and cerebral hyperperfusion postoperatively.
CASE DESCRIPTION: An 81-year-old man, presenting with left hemiparesis, underwent craniotomy for right organized CSH after 2-time burr-hole surgeries. After the craniotomy, the symptom improved, but on postoperative day 2, left hemiparesis, hemispatial neglect and hemisomatagnosia developed. Magnetic resonance imaging revealed SCLI on FLAIR images and single-photon emission computed tomography with N-isopropyl-p-[(123)I]-iodoamphetamine revealed cerebral hyperperfusion in the right hemispheric cortex. Antihypertensive treatment improved the symptoms gradually with improvement of the image findings, which resolved completely one month post-surgery.
CONCLUSIONS: The authors first reported a case of organized CSH, which showed postoperative neurologic deterioration, associated with prolonged cerebral hyperperfusion and SCLI on FLAIR images. Prolonged cerebral hyperperfusion could be a cause of postoperative neurologic deterioration in organized CSH.

PMID: 28359924 [PubMed - as supplied by publisher]

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