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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

                • Post-CEA hyperperfusion
                • Luxury perfusion
              • Definitions

                • Rare (3.5%) disorder most commonly occurring as complication of cerebral revascularization
                  • Mildly ↑ cerebral blood flow (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, mitochondrial encephalopathy lactic acidosis and stroke-like episodes (MELAS)]
                    • After drainage of chronic subdural hematomas

              IMAGING

              • General Features

                • Angiographic Findings

                  • Imaging Recommendations

                    • CT Findings

                      • MR Findings

                        • Other Modality Findings

                          • Ultrasonographic Findings

                            DIFFERENTIAL DIAGNOSIS

                              PATHOLOGY

                              • General Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          Selected References

                                          1. Lin YH et al: Update on cerebral hyperperfusion syndrome. J Neurointerv Surg. ePub, 2020
                                          2. Murai S et al: Safety and efficacy of staged angioplasty for patients at risk of hyperperfusion syndrome: a single-center retrospective study. Neuroradiology. 62(4):503-10, 2020
                                          3. Pavlov O: Rapid evacuation of chronic subdural hematoma - A possible traumatic brain injury (TBI). Med Hypotheses. 137:109539, 2020
                                          4. Sakata H et al: Symptomatic cerebral hyperperfusion after cerebral vasospasm associated with aneurysmal subarachnoid hemorrhage. World Neurosurg. 137:379-83, 2020
                                          5. Fassaert LMM et al: Transcranial Doppler 24 hours after carotid endarterectomy accurately identifies patients not at risk of cerebral hyperperfusion syndrome. Eur J Vasc Endovasc Surg. 58(3):320-7, 2019
                                          6. Ghuman M et al: Sentinel angiographic signs of cerebral hyperperfusion after angioplasty and stenting of intracranial atherosclerotic stenosis: A technical note. AJNR Am J Neuroradiol. 40(9):1523-5, 2019
                                          7. Lin T et al: ASL perfusion features and type of circle of Willis as imaging markers for cerebral hyperperfusion after carotid revascularization: a preliminary study. Eur Radiol. 29(5):2651-8, 2019
                                          8. Omura T et al: Cerebral hyperperfusion syndrome after a burr hole drainage surgery for chronic subdural hematoma. World Neurosurg. ePub, 2019
                                          9. Sharma P et al: Cerebral hyperperfusion syndrome after chronic subdural hematoma drainage. World Neurosurg. 126:694, 2019
                                          10. Huibers AE et al: Editor's choice - Cerebral hyperperfusion syndrome after carotid artery stenting: A systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 56(3):322-33, 2018
                                          11. Kirchoff-Torres KF et al: Cerebral hyperperfusion syndrome after carotid revascularization and acute ischemic stroke. Curr Pain Headache Rep. 22(4):24, 2018
                                          12. Galyfos G et al: Cerebral hyperperfusion syndrome and intracranial hemorrhage after carotid endarterectomy or carotid stenting: A meta-analysis. J Neurol Sci. 381:74-82, 2017
                                          13. Cano EJ et al: Asymmetric brain edema after cardiac transplantation: cerebroautoregulatory failure and relative hyperperfusion. Transplant Proc. 47(1):194-7, 2015
                                          14. Horie N et al: De novo ivy sign indicates postoperative hyperperfusion in moyamoya disease. Stroke. 45(5):1488-91, 2014
                                          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

                                                        • Post-CEA hyperperfusion
                                                        • Luxury perfusion
                                                      • Definitions

                                                        • Rare (3.5%) disorder most commonly occurring as complication of cerebral revascularization
                                                          • Mildly ↑ cerebral blood flow (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, mitochondrial encephalopathy lactic acidosis and stroke-like episodes (MELAS)]
                                                            • After drainage of chronic subdural hematomas

                                                      IMAGING

                                                      • General Features

                                                        • Angiographic Findings

                                                          • Imaging Recommendations

                                                            • CT Findings

                                                              • MR Findings

                                                                • Other Modality Findings

                                                                  • Ultrasonographic Findings

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  Selected References

                                                                                  1. Lin YH et al: Update on cerebral hyperperfusion syndrome. J Neurointerv Surg. ePub, 2020
                                                                                  2. Murai S et al: Safety and efficacy of staged angioplasty for patients at risk of hyperperfusion syndrome: a single-center retrospective study. Neuroradiology. 62(4):503-10, 2020
                                                                                  3. Pavlov O: Rapid evacuation of chronic subdural hematoma - A possible traumatic brain injury (TBI). Med Hypotheses. 137:109539, 2020
                                                                                  4. Sakata H et al: Symptomatic cerebral hyperperfusion after cerebral vasospasm associated with aneurysmal subarachnoid hemorrhage. World Neurosurg. 137:379-83, 2020
                                                                                  5. Fassaert LMM et al: Transcranial Doppler 24 hours after carotid endarterectomy accurately identifies patients not at risk of cerebral hyperperfusion syndrome. Eur J Vasc Endovasc Surg. 58(3):320-7, 2019
                                                                                  6. Ghuman M et al: Sentinel angiographic signs of cerebral hyperperfusion after angioplasty and stenting of intracranial atherosclerotic stenosis: A technical note. AJNR Am J Neuroradiol. 40(9):1523-5, 2019
                                                                                  7. Lin T et al: ASL perfusion features and type of circle of Willis as imaging markers for cerebral hyperperfusion after carotid revascularization: a preliminary study. Eur Radiol. 29(5):2651-8, 2019
                                                                                  8. Omura T et al: Cerebral hyperperfusion syndrome after a burr hole drainage surgery for chronic subdural hematoma. World Neurosurg. ePub, 2019
                                                                                  9. Sharma P et al: Cerebral hyperperfusion syndrome after chronic subdural hematoma drainage. World Neurosurg. 126:694, 2019
                                                                                  10. Huibers AE et al: Editor's choice - Cerebral hyperperfusion syndrome after carotid artery stenting: A systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 56(3):322-33, 2018
                                                                                  11. Kirchoff-Torres KF et al: Cerebral hyperperfusion syndrome after carotid revascularization and acute ischemic stroke. Curr Pain Headache Rep. 22(4):24, 2018
                                                                                  12. Galyfos G et al: Cerebral hyperperfusion syndrome and intracranial hemorrhage after carotid endarterectomy or carotid stenting: A meta-analysis. J Neurol Sci. 381:74-82, 2017
                                                                                  13. Cano EJ et al: Asymmetric brain edema after cardiac transplantation: cerebroautoregulatory failure and relative hyperperfusion. Transplant Proc. 47(1):194-7, 2015
                                                                                  14. Horie N et al: De novo ivy sign indicates postoperative hyperperfusion in moyamoya disease. Stroke. 45(5):1488-91, 2014