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Cerebral misery perfusion due to carotid occlusive disease

Maddula, Mohana; Sprigg, Nikola; Bath, Philip M.W.; Munshi, Sunil K.

Authors

Mohana Maddula

Nikola Sprigg

Philip M.W. Bath

Sunil K. Munshi



Abstract

Purpose Cerebral misery perfusion (CMP) is a condition where cerebral autoregulatory capacity is exhausted, and cerebral blood supply in insufficient to meet metabolic demand. We present an educational review of this important condition, which has a range of clinical manifestations.
Method A non-systematic review of published literature was undertaken on CMP and major cerebral artery occlusive disease, using Pubmed and Sciencedirect.
Findings Patients with CMP may present with strokes in watershed territories, collapses and transient ischaemic attacks or episodic movements associated with an orthostatic component. While positron emission tomography is the gold standard investigation for misery perfusion, advanced MRI is being increasingly used as an alternative investigation modality. The presence of CMP increases the risk of strokes. In addition to the devastating effect of stroke, there is accumulating evidence of impaired cognition and quality of life with carotid occlusive disease (COD) and misery perfusion. The evidence for revascularisation in the setting of complete carotid occlusion is weak. Medical management constitutes careful blood pressure management while addressing other vascular risk factors.
Discussion The evidence for the management of patients with COD and CMP is discussed, together with recommendations based on our local experience. In this review, we focus on misery perfusion due to COD.
Conclusion Patients with CMP and COD may present with a wide-ranging clinical phenotype and therefore to many specialties. Early identification of patients with misery perfusion may allow appropriate management and focus on strategies to maintain or improve cerebral blood flow, while avoiding potentially harmful treatment.

Journal Article Type Article
Journal Stroke and Vascular Neurology
Electronic ISSN 2059-8696
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Article Number e000067
APA6 Citation Maddula, M., Sprigg, N., Bath, P. M., & Munshi, S. K. (in press). Cerebral misery perfusion due to carotid occlusive disease. Stroke and Vascular Neurology, https://doi.org/10.1136/svn-2017-000067
DOI https://doi.org/10.1136/svn-2017-000067
Publisher URL https://doi.org/10.1136/svn-2017-000067
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc/4.0





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