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Cerebral Hyperperfusion Syndrome
Anne G. Osborn, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Cerebral hyperperfusion syndrome (CHS)
              • Synonyms

                • Postcarotid endarterectomy hyperperfusion
                • Luxury perfusion
              • Definitions

                • Rare (1-3%) disorder most commonly occurring as complication of cerebral revascularization
                  • Mildly ↑ CBF common after carotid endarterectomy (CEA), typically asymptomatic
                  • CHS defined as ≥ 100% increase in rCBF compared to preoperative values
                • Major increase in ipsilateral CBF well above normal metabolic demands
                  • Usually following carotid revascularization procedure
                    • Carotid endarterectomy
                    • Angioplasty with stenting
                    • Thrombolysis
                  • May occur in other settings (e.g., status epilepticus, MELAS)

              IMAGING

              • General Features

                • Imaging Recommendations

                  • CT Findings

                    • MR Findings

                      • Other Modality Findings

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      Selected References

                                      1. Cano EJ et al: Asymmetric brain edema after cardiac transplantation: cerebroautoregulatory failure and relative hyperperfusion. Transplant Proc. 47(1):194-7, 2015
                                      2. Fujimura M et al: Quantitative analysis of early postoperative cerebral blood flow contributes to the prediction and diagnosis of cerebral hyperperfusion syndrome after revascularization surgery for moyamoya disease. Neurol Res. 37(2):131-8, 2015
                                      3. Horie N et al: De novo ivy sign indicates postoperative hyperperfusion in moyamoya disease. Stroke. 45(5):1488-91, 2014
                                      4. Rafiq MK et al: Cerebral hyperperfusion syndrome. Pract Neurol. 14(1):64-6, 2014
                                      5. Brantley HP et al: Hyperperfusion syndrome following carotid artery stenting: the largest single-operator series to date. J Invasive Cardiol. 21(1):27-30, 2009
                                      6. Grunwald IQ et al: Hyperperfusion syndrome after carotid stent angioplasty. Neuroradiology. 51(3):169-74, 2009
                                      7. Kuroda H et al: Prediction of cerebral hyperperfusion after carotid endarterectomy using middle cerebral artery signal intensity in preoperative single-slab 3-dimensional time-of-flight magnetic resonance angiography. Neurosurgery. 64(6):1065-71; discussion 1071-2, 2009
                                      8. Medel R et al: Hyperperfusion syndrome following endovascular cerebral revascularization. Neurosurg Focus. 26(3):E4, 2009
                                      9. Moulakakis KG et al: Hyperperfusion syndrome after carotid revascularization. J Vasc Surg. 49(4):1060-8, 2009
                                      10. Tseng YC et al: Prediction of cerebral hyperperfusion syndrome after carotid stenting: a cerebral perfusion computed tomography study. J Comput Assist Tomogr. 33(4):540-5, 2009
                                      11. Hirooka R et al: Magnetic resonance imaging in patients with cerebral hyperperfusion and cognitive impairment after carotid endarterectomy. J Neurosurg. 108(6):1178-83, 2008
                                      12. Fukuda T et al: Prediction of cerebral hyperperfusion after carotid endarterectomy using cerebral blood volume measured by perfusion-weighted MR imaging compared with single-photon emission CT. AJNR Am J Neuroradiol. 28(4):737-42, 2007
                                      13. Park KY et al: Cortical sulcal effacement on brain CT associated with cerebral hyperperfusion after carotid artery stenting. J Neurol Sci. 260(1-2):83-6, 2007
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Pathology

                                              • Clinical Issues

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Cerebral hyperperfusion syndrome (CHS)
                                                  • Synonyms

                                                    • Postcarotid endarterectomy hyperperfusion
                                                    • Luxury perfusion
                                                  • Definitions

                                                    • Rare (1-3%) disorder most commonly occurring as complication of cerebral revascularization
                                                      • Mildly ↑ CBF common after carotid endarterectomy (CEA), typically asymptomatic
                                                      • CHS defined as ≥ 100% increase in rCBF compared to preoperative values
                                                    • Major increase in ipsilateral CBF well above normal metabolic demands
                                                      • Usually following carotid revascularization procedure
                                                        • Carotid endarterectomy
                                                        • Angioplasty with stenting
                                                        • Thrombolysis
                                                      • May occur in other settings (e.g., status epilepticus, MELAS)

                                                  IMAGING

                                                  • General Features

                                                    • Imaging Recommendations

                                                      • CT Findings

                                                        • MR Findings

                                                          • Other Modality Findings

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          Selected References

                                                                          1. Cano EJ et al: Asymmetric brain edema after cardiac transplantation: cerebroautoregulatory failure and relative hyperperfusion. Transplant Proc. 47(1):194-7, 2015
                                                                          2. Fujimura M et al: Quantitative analysis of early postoperative cerebral blood flow contributes to the prediction and diagnosis of cerebral hyperperfusion syndrome after revascularization surgery for moyamoya disease. Neurol Res. 37(2):131-8, 2015
                                                                          3. Horie N et al: De novo ivy sign indicates postoperative hyperperfusion in moyamoya disease. Stroke. 45(5):1488-91, 2014
                                                                          4. Rafiq MK et al: Cerebral hyperperfusion syndrome. Pract Neurol. 14(1):64-6, 2014
                                                                          5. Brantley HP et al: Hyperperfusion syndrome following carotid artery stenting: the largest single-operator series to date. J Invasive Cardiol. 21(1):27-30, 2009
                                                                          6. Grunwald IQ et al: Hyperperfusion syndrome after carotid stent angioplasty. Neuroradiology. 51(3):169-74, 2009
                                                                          7. Kuroda H et al: Prediction of cerebral hyperperfusion after carotid endarterectomy using middle cerebral artery signal intensity in preoperative single-slab 3-dimensional time-of-flight magnetic resonance angiography. Neurosurgery. 64(6):1065-71; discussion 1071-2, 2009
                                                                          8. Medel R et al: Hyperperfusion syndrome following endovascular cerebral revascularization. Neurosurg Focus. 26(3):E4, 2009
                                                                          9. Moulakakis KG et al: Hyperperfusion syndrome after carotid revascularization. J Vasc Surg. 49(4):1060-8, 2009
                                                                          10. Tseng YC et al: Prediction of cerebral hyperperfusion syndrome after carotid stenting: a cerebral perfusion computed tomography study. J Comput Assist Tomogr. 33(4):540-5, 2009
                                                                          11. Hirooka R et al: Magnetic resonance imaging in patients with cerebral hyperperfusion and cognitive impairment after carotid endarterectomy. J Neurosurg. 108(6):1178-83, 2008
                                                                          12. Fukuda T et al: Prediction of cerebral hyperperfusion after carotid endarterectomy using cerebral blood volume measured by perfusion-weighted MR imaging compared with single-photon emission CT. AJNR Am J Neuroradiol. 28(4):737-42, 2007
                                                                          13. Park KY et al: Cortical sulcal effacement on brain CT associated with cerebral hyperperfusion after carotid artery stenting. J Neurol Sci. 260(1-2):83-6, 2007