MRI evidence of reperfusion injury associated with neurological deficits after carotid revascularization procedures.
Cho, A-H. a,b; Suh, D-C. c; Kim, G. E. d; Kim, J. S. a; Lee, D. H. c; Kwon, S. U. a; Park, S. M. a; Kang, D-W. a
[Miscellaneous Article] European Journal of Neurology. 16(9):1066-1069, September 2009.

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Background and purpose: Some patients develop major neurological complications after carotid revascularization procedures, despite the lack of new infarcts or classical hyperperfusion syndrome.

Methods: In four patients who developed major neurological deficits after carotid revascularization procedures, but without evidence of new ischemic infarcts or hyperperfusion, we performed post-procedural MRI [diffusion-weighted image (DWI), perfusion-weighted image (PWI), pre-and post-contrast fluid-attenuated inversion recovery (FLAIR) image] immediately after and 1 day after the procedure.

Results: Post-gadolinium FLAIR images on 1 day after the procedures showed prominent leptomeningeal enhancements in the revascularized hemispheres. These radiological findings disappeared on follow-up FLAIR images accompanied by the clinical improvement over the following several days after the procedures.

Conclusion: Reperfusion syndrome may be associated with transient severe neurological deficits after carotid revascularization in patients without new ischemic events or classical hyperperfusion syndrome.

(C) 2009 Lippincott Williams & Wilkins, Inc.