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Crossed Cerebellar Diaschisis and Cerebral Infarction After Cerebral Hyperperfusion Syndrome Following Carotid Artery Stenting: A Case Report

Received: 28 December 2023     Accepted: 23 January 2024     Published: 21 February 2024
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Abstract

Crossed cerebellar diaschisis (CCD) often occurs after ischemic or hemorrhagic stroke that does great damage to the cortico-ponto-cerebellar pathway (CPCP). Nevertheless, as far as we know, CCD due to cerebral hyperperfusion syndrome (CHS) following carotid artery stenting (CAS) is rare. We report a case where CCD and new cerebral infarction after CHS following CAS was effectively treated by intravenous use of edaravone and mannitol. The patient was a 74-year-old female. She developed dizziness and vomiting accompanied with weakness of the right limb for 8 days and was admitted to our hospital. Computed tomography angiography scan revealed severe stenosis at the beginning of the left internal carotid artery. Further digital subtraction angiography (DSA) revealed severe stenosis at the beginning of the left internal carotid artery, with a stenosis rate of approximately 90%. Therefore, she underwent left CAS implantation. After the operation, the patient developed disturbance of consciousness and decreased muscle strength in the right limb. Intravenous infusion of edaravone and mannitol were then started. After 10 days of medical treatment, the condition of patient improved to mild hemiparesis. The findings in this present case strongly suggest that CHS after CAS for carotid artery stenosis may cause transient CCD.

Published in Clinical Medicine Research (Volume 13, Issue 1)
DOI 10.11648/j.cmr.20241301.13
Page(s) 13-16
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Carotid Artery Stenting, CCD, Hyperperfusion Syndrome, Carotid Artery Stenosis, Digital Subtraction Angiography

References
[1] Baron J C, Bousser M G, Comar D, Castaigne P. "Crossed cerebellar diaschisis" in human supratentorial brain infarction. Trans Am Neurol Assoc. 1981; 105: 459-461.
[2] Fu J, Chen W J, Wu G Y, Cheng J L, Wang M H, Zhuge Q, Li J C, et al. Whole-brain 320-detector row dynamic volume CT perfusion detected crossed cerebellar diaschisis after spontaneous intracerebral hemorrhage. Neuroradiology. 2015; 57(2): 179-187.
[3] Infeld B, Davis S M, Lichtenstein M, Mitchell P J, Hopper J L. Crossed cerebellar diaschisis and brain recovery after stroke. Stroke. 1995; 26(1): 90-95.
[4] Sobesky J, Thiel A, Ghaemi M, Hilker R H, Rudolf J, Jacobs A H, Herholz K, et al. Crossed cerebellar diaschisis in acute human stroke: a PET study of serial changes and response to supratentorial reperfusion. J Cereb Blood Flow Metab. 2005; 25(12): 1685-1691.
[5] Hokari M, Kuroda S, Simoda Y, Uchino H, Hirata K, Shiga T, Nakayama N, et al. Transient crossed cerebellar diaschisis due to cerebral hyperperfusion following surgical revascularization for moyamoya disease: case report. Neurol Med Chir (Tokyo). 2012; 52(5): 350-353.
[6] Kuroda S, Houkin K, Ishikawa T, Nakayama N, Iwasaki Y. Novel bypass surgery for moyamoya disease using pericranial flap: its impacts on cerebral hemodynamics and long-term outcome. Neurosurgery. 2010; 66(6): 1093-1101.
[7] Ogasawara K, Komoribayashi N, Kobayashi M, Fukuda T, Inoue T, Yamadate K, Ogawa A. Neural damage caused by cerebral hyperperfusion after arterial bypass surgery in a patient with moyamoya disease: case report. Neurosurgery. 2005; 56(6): E1380.
[8] Ogasawara K, Yamadate K, Kobayashi M, Endo H, Fukuda T, Yoshida K, Terasaki K, et al. Postoperative cerebral hyperperfusion associated with impaired cognitive function in patients undergoing carotid endarterectomy. J Neurosurg. 2005; 102(1): 38-44.
[9] Ichinose N, Hama S, Tsuji T, Soh Z, Hayashi H, Kiura Y, Sakamoto S, et al. Predicting ischemic stroke after carotid artery stenting based on proximal calcification and the jellyfish sign. J Neurosurg. 2018; 128(5): 1280-1288.
[10] Thomas D J. Protected carotid artery stenting versus endarterectomy in high-risk patients reflections from SAPPHIRE. Stroke. 2005; 36(4): 912-913.
[11] Mantese V A, Timaran C H, Chiu D, Begg R J, Brott T G. The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST): stenting versus carotid endarterectomy for carotid disease. Stroke. 2010; 41: (10 Suppl): S31-34.
[12] Dumont T M, Rughani A I. National trends in carotid artery revascularization surgery. J Neurosurg. 2012; 116(6): 1251-1257.
[13] Yadav J S, Wholey M H, Kuntz R E, Fayad P, Katzen B T, Mishkel G J Bajwa T K, et al. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004; 351(15): 1493-1501.
[14] Setacci C, Chisci E, Setacci F, Iacoponi F, de Donato G, Rossi A. Siena carotid artery stenting score: a risk modelling study for individual patients. Stroke. 2010; 41(6): 1259-1265.
[15] Schillinger M, Gschwendtner M, Reimers B, Trenkler J, Stockx L, Mair J, Macdonald S, Karnel F et al. Does carotid stent cell design matter? Stroke. 2008; 39(3): 905-909.
[16] Reigel M M, Hollier L H, Sundt TM Jr, Piepgras D G, Sharbrough F W, Cherry K J. Cerebral hyperperfusion syndrome: a cause of neurologic dysfunction after carotid endarterectomy. J Vasc Surg. 1987; 5(4): 628-634.
[17] Dalman J E, Beenakkers I C, Moll F L, Leusink J A, Ackerstaff R G. Transcranial Doppler monitoring during carotid endarterectomy helps to identify patients at risk of postoperative hyperperfusion. Eur J Vasc Endovasc Surg. 1999; 18(3): 222-227.
[18] Ogasawara K, Kobayashi M, Komoribayashi N, Fukuda T, Inoue T, Terasaki K, Ogaw A. Transient crossed cerebellar diaschisis secondary to cerebral hyperperfusion following carotid endarterectomy. Ann Nucl Med. 2005; 19(4): 321-324.
[19] Kushner M, Alavi A, Reivich M, Dann R, Burke A, Robinson G. Contralateral cerebellar hypometabolism following cerebral insult: a positron emission tomographic study. Ann Neurol. 1984; 15(5): 425-434.
[20] Pantano P, "Baron J C", Samson Y, Bousser M G, Derouesne C, Comar D. Crossed cerebellar diaschisis. Further studies. Brain. 1986; 109 (Pt 4): 677-694.
[21] Junck L, Gilman S, Rothley J R, Betley A T, Koeppe R A, Hichwa R D. A relationship between metabolism in frontal lobes and cerebellum in normal subjects studied with PET. J Cereb Blood Flow Metab. 1988; 8(6): 774-782.
Cite This Article
  • APA Style

    Ning, W., Chen, S., Diao, S., Zhong, S. (2024). Crossed Cerebellar Diaschisis and Cerebral Infarction After Cerebral Hyperperfusion Syndrome Following Carotid Artery Stenting: A Case Report. Clinical Medicine Research, 13(1), 13-16. https://doi.org/10.11648/j.cmr.20241301.13

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    ACS Style

    Ning, W.; Chen, S.; Diao, S.; Zhong, S. Crossed Cerebellar Diaschisis and Cerebral Infarction After Cerebral Hyperperfusion Syndrome Following Carotid Artery Stenting: A Case Report. Clin. Med. Res. 2024, 13(1), 13-16. doi: 10.11648/j.cmr.20241301.13

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    AMA Style

    Ning W, Chen S, Diao S, Zhong S. Crossed Cerebellar Diaschisis and Cerebral Infarction After Cerebral Hyperperfusion Syndrome Following Carotid Artery Stenting: A Case Report. Clin Med Res. 2024;13(1):13-16. doi: 10.11648/j.cmr.20241301.13

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  • @article{10.11648/j.cmr.20241301.13,
      author = {Wei-Qin Ning and Si-Qi Chen and Sheng-Peng Diao and Shui-Sheng Zhong},
      title = {Crossed Cerebellar Diaschisis and Cerebral Infarction After Cerebral Hyperperfusion Syndrome Following Carotid Artery Stenting: A Case Report},
      journal = {Clinical Medicine Research},
      volume = {13},
      number = {1},
      pages = {13-16},
      doi = {10.11648/j.cmr.20241301.13},
      url = {https://doi.org/10.11648/j.cmr.20241301.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20241301.13},
      abstract = {Crossed cerebellar diaschisis (CCD) often occurs after ischemic or hemorrhagic stroke that does great damage to the cortico-ponto-cerebellar pathway (CPCP). Nevertheless, as far as we know, CCD due to cerebral hyperperfusion syndrome (CHS) following carotid artery stenting (CAS) is rare. We report a case where CCD and new cerebral infarction after CHS following CAS was effectively treated by intravenous use of edaravone and mannitol. The patient was a 74-year-old female. She developed dizziness and vomiting accompanied with weakness of the right limb for 8 days and was admitted to our hospital. Computed tomography angiography scan revealed severe stenosis at the beginning of the left internal carotid artery. Further digital subtraction angiography (DSA) revealed severe stenosis at the beginning of the left internal carotid artery, with a stenosis rate of approximately 90%. Therefore, she underwent left CAS implantation. After the operation, the patient developed disturbance of consciousness and decreased muscle strength in the right limb. Intravenous infusion of edaravone and mannitol were then started. After 10 days of medical treatment, the condition of patient improved to mild hemiparesis. The findings in this present case strongly suggest that CHS after CAS for carotid artery stenosis may cause transient CCD.
    },
     year = {2024}
    }
    

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    T1  - Crossed Cerebellar Diaschisis and Cerebral Infarction After Cerebral Hyperperfusion Syndrome Following Carotid Artery Stenting: A Case Report
    AU  - Wei-Qin Ning
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    AB  - Crossed cerebellar diaschisis (CCD) often occurs after ischemic or hemorrhagic stroke that does great damage to the cortico-ponto-cerebellar pathway (CPCP). Nevertheless, as far as we know, CCD due to cerebral hyperperfusion syndrome (CHS) following carotid artery stenting (CAS) is rare. We report a case where CCD and new cerebral infarction after CHS following CAS was effectively treated by intravenous use of edaravone and mannitol. The patient was a 74-year-old female. She developed dizziness and vomiting accompanied with weakness of the right limb for 8 days and was admitted to our hospital. Computed tomography angiography scan revealed severe stenosis at the beginning of the left internal carotid artery. Further digital subtraction angiography (DSA) revealed severe stenosis at the beginning of the left internal carotid artery, with a stenosis rate of approximately 90%. Therefore, she underwent left CAS implantation. After the operation, the patient developed disturbance of consciousness and decreased muscle strength in the right limb. Intravenous infusion of edaravone and mannitol were then started. After 10 days of medical treatment, the condition of patient improved to mild hemiparesis. The findings in this present case strongly suggest that CHS after CAS for carotid artery stenosis may cause transient CCD.
    
    VL  - 13
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Author Information
  • Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou, China

  • Emergency Department, Huadu Hospital Affiliated to Southern Medical University, Guangzhou, China

  • Department of Neurology, The First Affiliated Hospital, School of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, China

  • Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou, China

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