MRI evidence of reperfusion injury associated with neurological deficits after carotid revascularization procedures

Eur J Neurol. 2009 Sep;16(9):1066-9. doi: 10.1111/j.1468-1331.2009.02650.x. Epub 2009 May 22.


Background and purpose: Some patients develop major neurological complications after carotid revascularization procedures, despite the lack of new infarcts or classical hyperperfusion syndrome.

Methods: In four patients who developed major neurological deficits after carotid revascularization procedures, but without evidence of new ischemic infarcts or hyperperfusion, we performed post-procedural MRI [diffusion-weighted image (DWI), perfusion-weighted image (PWI), pre-and post-contrast fluid-attenuated inversion recovery (FLAIR) image] immediately after and 1 day after the procedure.

Results: Post-gadolinium FLAIR images on 1 day after the procedures showed prominent leptomeningeal enhancements in the revascularized hemispheres. These radiological findings disappeared on follow-up FLAIR images accompanied by the clinical improvement over the following several days after the procedures.

Conclusion: Reperfusion syndrome may be associated with transient severe neurological deficits after carotid revascularization in patients without new ischemic events or classical hyperperfusion syndrome.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain / physiopathology*
  • Brain Mapping
  • Carotid Arteries / physiopathology
  • Cerebral Revascularization / adverse effects*
  • Diagnostic Imaging
  • Humans
  • Image Processing, Computer-Assisted
  • Male
  • Nervous System Diseases / etiology*
  • Nervous System Diseases / physiopathology
  • Reperfusion Injury / complications*
  • Reperfusion Injury / physiopathology