BACKGROUND AND PURPOSE: BOLD MR imaging combined with a technique for precision control of end-tidal pCO 2 was used to produce quantitative maps of CVR in patients with Moyamoya disease. The technique was validated against measures of disease severity by using conventional angiography; it then was used to study the relationship between CVR, vascular steal, and disease severity.

Perfusion-based SPECT staging correlates well with clinical symptoms and may be a reliable alternative to the Suzuki staging by CA.

The sinking skin flap syndrome (SSFS) is a rare complication after a large craniectomy. Hemorrhage infarction after a cranioplasty is a very rare complication with only 4 cases to date. We report a case of the patient who underwent an autologous cranioplasty to treat SSFS that developed intracerebral hemorrhage infarction. A 20-year-old male was admitted to our emergency department with stuporous mentality. Emergent decompressive craniectomy (DC) have done. He had suffered from SSFS and fever of unknown origin (FUO) since DC. After 7 months of craniectomy, cranioplasty was done. After 1 day of surgery, acute infarction with hemorrhagic transformation involved left cerebral hemisphere. We controlled increased intracranial pressure by using osmotic diuretics, steroid and antiepileptic drugs. After 14 day of surgery, he improved neurological symptoms and he had not any more hyperthermia. Among several complication of large cranioplasty only 4 cases of intracerebral hemorrhagic infarction due to reperfusion injury has been reported. In this case, unstable autoregulation system made brain hypoxic damage and then reperfusion and recanalization of cerebral vessels resulted in intracerebral hemorrhagic infarction. 7 month long FUO was resolved by cranioplasty.

Central pontine myelinolysis (CPM) is one of the encephalopathy that results from extreme fluctuations in serum sodium concentration and plasma osmolality. CPM after non aneurysmal perimesencephalic subarachnoid hemorrhage (NPSAH) is very rare. A 53-year-old female patient aggravated her instabilty 3 weeks after treatment of after NPSAH. Brain CT showed a prominent low-density lesion in the central pons. Vasospasm, pontine infarct, multiple sclerosis must be excluded after subarachnoid hemorrhage. Her brain magnetic resonance imaging (MRI) of the brainstem revealed CPM. The peripheral fiber sparing, central trident appearance was observed. Peripheral fiber sparing is more prominent, but central trident is disappearing at long-term follow-up MRI. CPM can develop even after NPSAH as well as aneurysmal subarachnoid hemorrhage. Trident pattern in pons area and peripheral fiber sparing is differential diagnosis with vasospasm, cerebral infarct and multiple sclerosis after NPSAH.