Radiological aspects of cerebral hyperperfusion syndrome diagnosis. Lecture

Several aspects of diagnostic radiology are considered, particularly concerning the occurrence of stroke and cerebral hyperperfusion after carotid and coronary artery revascularization.

Hypoperfusion is the main subject of concern for neurologists and neuroradiologists in the clinical practice, even though hyperperfusion also has an important clinical and prognostic value. Acute pathological hyperperfusion after carotid endarterectomy and venous stroke following cerebral venous sinus thrombosis with a two- or three-fold increase in regional cerebral blood flow have a high risk of hemorrhage. A more favorable condition is benign hyperperfusion with moderate (up to 30%) plethora. It develops during venous stroke as element of the pathogenesis of brain tissue injury after secondary ischemia. Often patients who have undergone the simultaneous carotid and coronary surgery or CABG in the early postoperative period showed signs of neurological deterioration in the form of moderate postischemic hyperperfusion. Timely diagnosis can prevent severe cerebral complications during cerebral venous sinus thrombosis or postoperative adverse events in patients with coronary and carotid artery injuries. CT perfusion is the fastest and most adapted tool for emergency diagnostics, whereas SPECT provides a non-invasive assessment of perfusion and brain tissue metabolism with less radiation and fewer negative effects, such as allergic reactions.

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