Acute Cerebral Ischemia After Intracranial Bleeding in Unilateral Moyamoya Disease Case Report

• Published in: Neurologia medico-chirurgica Vol. 52; no. 5; pp. 346 - 349
• Main Authors: SHIBAMOTO, Kazunori, AOYAMA, Kunihiro, TAKI, Hideaki, MIYASAKI, Akihiro
• Format: Journal Article
• Language: English; Japanese
• Published: Japan The Japan Neurosurgical Society 2012; THE JAPAN NEUROSURGICAL SOCIETY
• Subjects: Acute Disease; Adult; Brain Edema - etiology; Brain Edema - prevention & control; Brain Edema - therapy; Brain Ischemia - diagnosis; Brain Ischemia - etiology; Brain Ischemia - therapy; Cerebral Angiography - methods; Cerebral Hemorrhage - diagnosis; Cerebral Hemorrhage - etiology; Cerebral Hemorrhage - surgery; cerebral infarction; Humans; Hypothermia, Induced - methods; Infarction, Middle Cerebral Artery - complications; Infarction, Middle Cerebral Artery - diagnosis; Infarction, Middle Cerebral Artery - physiopathology; intracranial bleeding; Intracranial Hypertension - etiology; Intracranial Hypertension - prevention & control; Intracranial Hypertension - therapy; Male; Moyamoya Disease - complications; Moyamoya Disease - diagnosis; Moyamoya Disease - physiopathology; perfusion computed tomography; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Postoperative Complications - therapy; Tomography, X-Ray Computed - methods; unilateral moyamoya disease
• ISSN: 0470-8105; 1349-8029
• DOI: 10.2176/nmc.52.346

A 31-year-old male presenting with intracranial hemorrhage manifesting as deep coma and anisocoria underwent immediate emergency surgery. Three-dimensional computed tomography (CT) angiography revealed stenosis of the right middle cerebral artery (MCA) and perfusion CT immediately after the surgery suggested severe hypoperfusion in the right MCA territory. Postoperative angiography demonstrated right unilateral moyamoya disease. We predicted that brain edema and intracranial pressure (ICP) elevation occurring after the hemorrhage might result in cerebral infarction. Hyperosmotic drugs were contraindicated by dehydration. Therefore, therapeutic hypothermia was induced that controlled the ICP. We considered that the increased ICP, dehydration, vasospasm, and shrinkage of the ruptured vessel comprised the pathogenesis of acute cerebral ischemia after intracranial bleeding. Cerebral hemodynamics should be evaluated during the acute phase of cerebral hemorrhage to prevent subsequent cerebral infarction.