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Cerebral misery perfusion diagnosed using hypercapnic blood-oxygenation-level-dependent contrast functional magnetic resonance imaging: a case report

Gordon, Adam L.; Goode, Stephen; D'Souza, Olympio; Auer, Dorothee P.; Munshi, Sunil K.

Authors

Adam L. Gordon adam.gordon@nottingham.ac.uk

Stephen Goode

Olympio D'Souza

Dorothee P. Auer

Sunil K. Munshi

Abstract

Introduction
Cerebral misery perfusion represents a failure of cerebral autoregulation. It is animportant differential diagnosis in post-stroke patients presenting with collapses in the presence of haemodynamically significant cerebrovascular stenosis. This is particularly the case when cortical or internal watershed infarcts are present. When this condition occurs, further investigation should be done immediately.

Case presentation
A 50-year-old Caucasian man presented with a stroke secondary to complete occlusion of his left internal carotid artery. He went on to suffer recurrent seizures. Neuroimaging demonstrated numerous new watershed-territory cerebral infarcts. No source of arterial thromboembolism was demonstrable. Hypercapnic blood-oxygenation-level-dependent-contrast functional magnetic resonance imaging was used to measure his cerebrovascular reserve capacity. The findings
were suggestive of cerebral misery perfusion.

Conclusions
Blood-oxygenation-level-dependent-contrast functional magnetic resonance imaging allows the inference of cerebral misery perfusion. This procedure is cheaper and more readily available than positron emission tomography imaging, which is the current gold standard diagnostic test. The most evaluated treatment for cerebral misery perfusion is extracranial-intracranial bypass. Although previous trials of this have been unfavourable, the results of new studies involving extracranial-intracranial bypass in high-risk patients identified during cerebral perfusion imaging are awaited.

Cerebral misery perfusion is an important and under-recognized condition in which emerging imaging and treatment modalities present the possibility of practical and evidence-based management in the near future. Physicians should thus be aware of this disorder and of recent developments in diagnostic tests that allow its detection.

Journal Article Type Article
Publication Date Feb 18, 2010
Journal Journal of Medical Case Reports
Electronic ISSN 1752-1947
Publisher Humana Press
Peer Reviewed Peer Reviewed
Volume 4
Issue 1
DOI https://doi.org/10.1186/1752-1947-4-54
Publisher URL http://jmedicalcasereports.com/content/4/1/54
Copyright Statement Copyright information regarding this work can be found at the following address: http://eprints.nottingh.../end_user_agreement.pdf

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://eprints.nottingham.ac.uk/end_user_agreement.pdf



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