Satoru Tanioka1, Yu Sato2, Kazuhiko Tsuda2, Shigehiko Niwa2, Hidenori Suzuki3. 1. Department of Neurosurgery, Matsusaka Central General Hospital, Matsusaka, Mie, Japan. Electronic address: satoru-tanioka@umin.net. 2. Department of Neurosurgery, Matsusaka Central General Hospital, Matsusaka, Mie, Japan. 3. Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.
Abstract
BACKGROUND: Cerebral 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 DESCRIPTION: An 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. CONCLUSIONS: A 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.
BACKGROUND: Cerebral 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 DESCRIPTION: An 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. CONCLUSIONS: A 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.