• Kuniaki Ogasawara, Nobukazu Komoribayashi, Masakazu Kobayashi, Takeshi Fukuda, Takashi Inoue, Keiko Yamadate, and Akira Ogawa.
• Department of Neurosurgery, Cyclotron Research Center, Iwate Medical University, Morioka, Japan. kuogasa@iwate-med.ac.jp
• Neurosurgery. 2005 Jun 1; 56 (6): E1380; discussion E1380.

Objective And ImportanceThe prognosis of cerebral hyperperfusion syndrome after vascular reconstructive surgery, including extracranial-intracranial arterial bypass, is not poor unless intracerebral hemorrhage develops secondary to hyperperfusion.Clinical PresentationA 48-year-old man with symptomatic moyamoya disease with misery perfusion in the right cerebral hemisphere underwent double right superficial temporal artery-to-middle cerebral artery bypasses. The postoperative course was uneventful until the patient developed headache and agitated delirium on the 4th postoperative day.InterventionPerfusion computed tomographic imaging demonstrated hyperperfusion in the right temporal lobe. The symptoms resolved by institution of intensive blood pressure control. Positron emission tomography performed 2 months after surgery demonstrated a postoperative reduction of the cerebral metabolic rate of oxygen in the right temporal lobe, where brain atrophy was observed on magnetic resonance images 3 months postoperatively. Neuropsychological testing performed 3 months postoperatively showed worsening digit span, which adversely affected the patient's quality of life.ConclusionThe current case suggests that cerebral hyperperfusion after vascular reconstructive surgery can cause irreversible neural damage, which results in cognitive impairment.

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