ABSTRACT
A 60-year-old woman presented with a rare case of hyperperfusion syndrome after stent placement for subclavian artery stenosis manifesting as dizziness due to vertebrobasilar insufficiency. Three days after undergoing stent placement to treat the severely stenotic (90%) right subclavian artery, she suffered intracranial hemorrhage related to hyperperfusion syndrome. Preoperative single-photon emission computed tomography findings of low cerebral perfusion and poor perfusion reserve might indicate the possibility of hyperperfusion syndrome after stenting in patients with subclavian artery stenosis.
Subject(s)
Hyperemia/etiology , Intracranial Hemorrhages/etiology , Stents , Subclavian Steal Syndrome/therapy , Cerebral Angiography , Female , Humans , Hyperemia/diagnosis , Intracranial Hemorrhages/diagnosis , Magnetic Resonance Angiography , Middle Aged , Risk Factors , Subclavian Steal Syndrome/diagnosis , Syndrome , Technetium Tc 99m Exametazime , Tomography, Emission-Computed, Single-Photon , Tomography, X-Ray Computed , Vertebrobasilar Insufficiency/diagnosis , Vertebrobasilar Insufficiency/therapyABSTRACT
BACKGROUND: Nobody knows whether cognitive dysfunction affects survival. Furthermore, it is unknown whether the dysfunction is caused by the tumor itself or by its treatment. METHODS: Patients with 20 gliomas (LGG, 7; MG, 13 [AG, 4; GM, 9]) in the right brain (nondominant) and 11 gliomas (LGG, 1; MG, 10 [AG, 6; GM, 4]) in the left brain (dominant) were studied. Thirty-four patients with meningioma were also studied. Cognitive function was evaluated by the 3MS examination, and propriety of radical resection of tumor was reviewed. RESULTS: Cognitive function pre-Op and post-Op was normal in patients with LGG and MGs in the right brain but decreased before an Op in all patients with MG in the left brain, and they did not normalize after Op. In patients with MG in left brain, the test of temporal and spatial orientation, first recall, similarities, 4-legged animals, mental reversal, and writing decreased after Op. Cognitive hypofunction before or after Op did not correlate with tumor malignancy and degree of tumor resection. CONCLUSION: Firstly, radical Op should aim at improvement of cognitive function for patients with glioma in the right brain, and for patients with glioma in the left brain, QOL should be thought about without expecting improvement of cognitive function. Secondly, improvement of cognitive function cannot be anticipated in patients with meningioma in the left brain. Aged patients older than 75 years require carefulness in Op. Then, damage of the cingulated gyrus and corpus callosum should be avoided in the left brain. This study emphasizes that clinicians should be careful in the evaluation of cognitive function in glioma and meningioma treatment.
