• World Neurosurg · May 2017

    Case Reports

    Prolonged Cerebral Hyperperfusion and Subcortical Low Intensity on Fluid Attenuated Inversion Recovery Images: Unusual Manifestation after Removal of Organized Chronic Subdural Hematoma.

    • Satoru Tanioka, Yu Sato, Kazuhiko Tsuda, Shigehiko Niwa, and Hidenori Suzuki.
    • Department of Neurosurgery, Matsusaka Central General Hospital, Matsusaka, Mie, Japan. Electronic address: satoru-tanioka@umin.net.
    • World Neurosurg. 2017 May 1; 101: 812.e1-812.e4.

    BackgroundCerebral hyperperfusion sometimes occurs after removal of chronic subdural hematoma (CSH) and usually resolves within a few days without any symptoms. Subcortical low intensity (SCLI) on fluid-attenuated inversion recovery (FLAIR) magnetic resonance images is rare and has been reported in some diseases other than CSH. A case of organized CSH who suffered prolonged neurologic deterioration, SCLI, and cerebral hyperperfusion postoperatively is described.Case DescriptionAn 81-year-old man, presenting with left hemiparesis, underwent craniotomy for right organized CSH after 2 burr-hole surgeries. After the craniotomy, the symptoms improved, but on postoperative day 2, left hemiparesis, hemispatial neglect, and hemiasomatognosia developed. Magnetic resonance imaging revealed SCLI on FLAIR images, and single-photon emission computed tomography with N-isopropyl-p-[123I]-iodoamphetamine revealed cerebral hyperperfusion in the right hemispheric cortex. Antihypertensive treatment improved the symptoms gradually, which resolved completely 1 month postsurgery.ConclusionsA case of organized CSH, which showed postoperative neurologic deterioration associated with prolonged cerebral hyperperfusion and SCLI on FLAIR images, is reported. Prolonged cerebral hyperperfusion could be a cause of postoperative neurologic deterioration in organized CSH.Copyright © 2017 Elsevier Inc. All rights reserved.

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