Limits...
Superficial temporal artery-to-middle cerebral artery bypass surgery for middle cerebral artery stenosis in a patient with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy.

Muta D, Kawano T, Shinojima N, Kuratsu J - Springerplus (2015)

Bottom Line: Ischemic events are the main clinical manifestation of this condition.Cerebral blood flow and cerebrovascular reactivity were effectively improved using double anastomoses.To our knowledge, surgical revascularization for patients with this condition has not yet been described in the literature.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjyo, Chuoku, Kumamoto, 8608556 Japan.

ABSTRACT
Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy is a rare hereditary small vessel disease. Ischemic events are the main clinical manifestation of this condition. Here, we present a case in which superficial temporal artery-to-middle cerebral artery anastomosis was performed in a patient with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy who developed cerebral infarctions caused by severe middle cerebral artery stenosis. Cerebral blood flow and cerebrovascular reactivity were effectively improved using double anastomoses. To our knowledge, surgical revascularization for patients with this condition has not yet been described in the literature. Superficial temporal artery-to-middle cerebral artery anastomosis is effective for patients with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy who show marked regional cerebral hypoperfusion.

No MeSH data available.


Related in: MedlinePlus

Preoperative SPECT revealed the localized hypoperfusion in the right posterior MCA territory (a), and decreased CVR was detected by ACZ challenge (b). Improvement of the CBF (c) and CVR (d) was identified on postoperative SPECT
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4628037&req=5

Fig4: Preoperative SPECT revealed the localized hypoperfusion in the right posterior MCA territory (a), and decreased CVR was detected by ACZ challenge (b). Improvement of the CBF (c) and CVR (d) was identified on postoperative SPECT

Mentions: On clinical examinations, the patient was normotensive. A neurological examination revealed dysphasia, dyslexia, and numbness of the left fingers. Multifocal acute subcortical infarctions were found in the watershed area between the right MCA and the posterior cerebral artery on diffusion-weighted imaging sequences (Fig. 1). MR angiography confirmed severe stenosis of the right MCA that had not been present 6 months prior (Fig. 2a, b). MR imaging (MRI) demonstrated typical increased T2-signal intensity indicating white matter abnormalities in the left anterior temporal lobe, both anterior frontal lobes, external capsules, and periventricular regions (Fig. 3a, b). Some cerebral microbleeds (CMBs) were also present in both the basal ganglia and the subcortical areas. The patient was diagnosed with atherosclerotic infarction and treated with anti-thrombotic therapy. His symptoms were relieved and he was discharged. However, he presented with transient ischemic attacks (TIAs) characterized by left hand motor weakness several times after discharge despite receiving oral antiplatelet treatment. One month after the infarction, [123I] N-isopropyl-p-iodoamphetamine single photon emission computed tomography (IMP-SPECT) revealed a significant decrease in regional CBF (Fig. 4a) and CVR (Fig. 4b) under the acetazolamide challenge test occurring predominantly in the territory of the right MCA. Therefore, a superficial temporal artery (STA)-MCA anastomosis was planned to improve blood flow on the right side. Preoperative MRI revealed a newly developed cerebral infarction in the right corona radiata (data not shown).Fig. 1


Superficial temporal artery-to-middle cerebral artery bypass surgery for middle cerebral artery stenosis in a patient with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy.

Muta D, Kawano T, Shinojima N, Kuratsu J - Springerplus (2015)

Preoperative SPECT revealed the localized hypoperfusion in the right posterior MCA territory (a), and decreased CVR was detected by ACZ challenge (b). Improvement of the CBF (c) and CVR (d) was identified on postoperative SPECT
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4628037&req=5

Fig4: Preoperative SPECT revealed the localized hypoperfusion in the right posterior MCA territory (a), and decreased CVR was detected by ACZ challenge (b). Improvement of the CBF (c) and CVR (d) was identified on postoperative SPECT
Mentions: On clinical examinations, the patient was normotensive. A neurological examination revealed dysphasia, dyslexia, and numbness of the left fingers. Multifocal acute subcortical infarctions were found in the watershed area between the right MCA and the posterior cerebral artery on diffusion-weighted imaging sequences (Fig. 1). MR angiography confirmed severe stenosis of the right MCA that had not been present 6 months prior (Fig. 2a, b). MR imaging (MRI) demonstrated typical increased T2-signal intensity indicating white matter abnormalities in the left anterior temporal lobe, both anterior frontal lobes, external capsules, and periventricular regions (Fig. 3a, b). Some cerebral microbleeds (CMBs) were also present in both the basal ganglia and the subcortical areas. The patient was diagnosed with atherosclerotic infarction and treated with anti-thrombotic therapy. His symptoms were relieved and he was discharged. However, he presented with transient ischemic attacks (TIAs) characterized by left hand motor weakness several times after discharge despite receiving oral antiplatelet treatment. One month after the infarction, [123I] N-isopropyl-p-iodoamphetamine single photon emission computed tomography (IMP-SPECT) revealed a significant decrease in regional CBF (Fig. 4a) and CVR (Fig. 4b) under the acetazolamide challenge test occurring predominantly in the territory of the right MCA. Therefore, a superficial temporal artery (STA)-MCA anastomosis was planned to improve blood flow on the right side. Preoperative MRI revealed a newly developed cerebral infarction in the right corona radiata (data not shown).Fig. 1

Bottom Line: Ischemic events are the main clinical manifestation of this condition.Cerebral blood flow and cerebrovascular reactivity were effectively improved using double anastomoses.To our knowledge, surgical revascularization for patients with this condition has not yet been described in the literature.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjyo, Chuoku, Kumamoto, 8608556 Japan.

ABSTRACT
Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy is a rare hereditary small vessel disease. Ischemic events are the main clinical manifestation of this condition. Here, we present a case in which superficial temporal artery-to-middle cerebral artery anastomosis was performed in a patient with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy who developed cerebral infarctions caused by severe middle cerebral artery stenosis. Cerebral blood flow and cerebrovascular reactivity were effectively improved using double anastomoses. To our knowledge, surgical revascularization for patients with this condition has not yet been described in the literature. Superficial temporal artery-to-middle cerebral artery anastomosis is effective for patients with cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy who show marked regional cerebral hypoperfusion.

No MeSH data available.


Related in: MedlinePlus