Slowly progressive neuronal death associated with postischemic hyperperfusion in cortical laminar necrosis after high-flow bypass for a carotid intracavernous aneurysm: Case report

Koji Iihara, Masakazu Okawa, Tomohito Hishikawa, Naoaki Yamada, Kazuhito Fukushima, Hidehiro Iida, Susumu Miyamoto

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The authors report a rare case of slowly progressive neuronal death associated with postischemic hyperperfusion in cortical laminar necrosis after radial artery/external carotid artery-middle cerebral artery bypass graft surgery for an intracavernous carotid artery aneurysm. Under barbiturate protection, a 69-year-old man underwent high-flow bypass surgery combined with carotid artery sacrifice for a symptomatic intracavernous aneurysm. The patient became restless postoperatively, and this restlessness peaked on postoperative Day (POD) 7. Diffusion-weighted and FLAIR MR images obtained on PODs 1 and 7 revealed subtle cortical hyperintensity in the temporal cortex subjected to temporary occlusion. On POD 13, 123I-iomazenil (123I-IMZ) SPECT clearly showed increased distribution on the early image and mildly decreased binding on the delayed image with count ratios of the affected-unaffected corresponding regions of interest of 1.23 and 0.84, respectively, suggesting postischemic hyperperfusion. This was consistent with the finding on 123I-iodoamphetamine SPECT. Of note, neuronal density in the affected cortex on the delayed 123I-IMZ image further decreased to the affected/unaffected ratio of 0.44 on POD 55 during the subacute stage when characteristic cortical hyperintensity on T1-weighted MR imaging, typical of cortical laminar necrosis, was emerging. The affected cortex showed marked atrophy 8 months after the operation despite complete neurological recovery. This report illustrates, for the first time, dynamic neuroradiological correlations between slowly progressive neuronal death shown by 123I-IMZ SPECT and cortical laminar necrosis on MR imaging in human stroke.

Original languageEnglish
Pages (from-to)1254-1259
Number of pages6
JournalJournal of Neurosurgery
Issue number6
Publication statusPublished - Jun 1 2010
Externally publishedYes


All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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