Acute cerebral ischemia following intraventricular hemorrhage in moyamoya disease: early perfusion computed tomography findings

Abstract

The authors present a rare case of an infarction complication 15 days following acute intraventricular bleeding due to moyamoya disease. Before the infarction occurred, perfusion CT imaging disclosed early but reversible ischemic injury on the day of hemorrhage. Dehydration and hypotension are both possibly contributing factors of progressive injury from reversible ischemia due to infarction. Although the patient underwent successful bypass surgery, 1 month after the ictus the neurobehavior evaluation still showed marked executive dysfunction. The authors address that, in hemorrhagic-type moyamoya disease, early perfusion CT scanning is not only a powerful tool to identify the high-risk group of patients who could experience subacute infarction, but also alarms neurosurgeons to eliminate any predisposing factors when it shows reversible ischemic injuries.

Neuroendoscopic Findings of Ventricular Wall in Adult Hemorrhagic Moyamoya Disease: Report of Two Cases

“…Continuous high intracranial pressure (ICP) due to massive hemorrhage and obstructive hydrocephalus induces insufficient collateral flow resulting in irreversible ischemic damage. [13][14][15] Therefore, ICP must be controlled adequately after intraventricular hemorrhage to prevent late-onset cerebral infarction. [13][14][15] Intraventricular hematoma may also induce late-onset vasospasm.…”

“…[13][14][15] Therefore, ICP must be controlled adequately after intraventricular hemorrhage to prevent late-onset cerebral infarction. [13][14][15] Intraventricular hematoma may also induce late-onset vasospasm. 16,17) The pathology of late-onset infarction is unclear, but may be indirectly related to ICP change caused by hydrocephalus and hematoma after intraventricular hemorrhage.…”

Acute Cerebral Ischemia After Intracranial Bleeding in Unilateral Moyamoya Disease

“…1,4,8,9,[11][12][13] Infarction occurred in these patients mainly during the subacute stage between postictal days 7 and 16, with the exception of two patients in whom infarction and intracranial bleed- ing occurred simultaneously. 1,8) Increased ICP, dehydration, vasospasm, and shrinkage of the ruptured vessels have been proposed as the components of the pathogenesis.…”

Reversibility of Ischemic Findings on 3-T T2*-Weighted Imaging After Emergency Superficial Temporal Artery-Middle Cerebral Artery Anastomosis in Patients With Progressive Ischemic Stroke -Two Case Reports-

“…4,9,11) Dehydration, 4) hypotension, 4) increased intracranial pressure (ICP), 4) coagulation anomalies, 9) and vasospasm 9) are all factors proposed to contribute to ischemic injury. Case 1 had a 6-month history of transient ischemic attacks, suggesting that the brain was hemodynamically compromised.…”