Reversal of focal “misery-perfusion syndrome” by extra-intracranial arterial bypass in hemodynamic cerebral ischemia a case study with18o positron emission tomography

Abstract

Tomogrephic images of cerebral blood flow (CBF) and oxygen extraction fraction (OEF) using the14O continuous inhalation technique, and positron emission tomography, were obtained from a patient with cerebral ischemia distal to an occluded left internal carotid artery. There was a focal mismatch between CBF and oxygen metabolism in the brain supplied by tbe middle cerebral artery where CBF was decreased and OEF increased (“misery-perfusion syndrome” as opposed to “luxury-perfusioa syndrome”). These abnormalities were most marked in tbe parieto-ocdpital watershed area. After left superficial temporal to middle cerebral artery anastomosis, the clinical attacks ceased and a repeat study did not demonstrate tbe prerious CBF and OEF abnormalities. This suggests that this pattern of abnormalities indicates potential liable tissue. The concept of “mlsery-perfuslon” may be of some importance In tbe patbophysiological mechanisms of hemodynamic cerebral ischemia and serve as a rational basis for rerascularization procedures. © 1981 American Heart Association, Inc.