Transient crossed cerebellar diaschisis due to cerebral hyperperfusion following surgical revascularization for moyamoya disease: case report

Neurol Med Chir (Tokyo). 2012;52(5):350-3. doi: 10.2176/nmc.52.350.

Abstract

Crossed cerebellar diaschisis (CCD) often occurs after ischemic or hemorrhagic stroke that damages the cortico-ponto-cerebellar pathway. However, CCD due to cerebral hyperperfusion following cerebrovascular reconstruction is rare. A 61-year-old woman presented with transient CCD due to cerebral hyperperfusion following bypass surgery for adult moyamoya disease. She developed transient weakness of the right extremities and was diagnosed with moyamoya disease. First, she underwent superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis with indirect synangiosis on the left. Postoperative course was uneventful. Subsequently, she underwent STA-MCA anastomosis with indirect synangiosis on the right. She complained of mild headache on the right, and single photon emission computed tomography (SPECT) performed on the 7th postoperative day demonstrated hyperperfusion in the right frontal and temporal lobes associated with hypoperfusion in the left cerebellum. Magnetic resonance (MR) imaging demonstrated no new lesions and MR angiography showed patent STA-MCA bypass. Subsequent SPECT showed disappearance of both hyperperfusion and CCD. This case strongly suggests that cerebral hyperperfusion after bypass surgery for moyamoya disease may cause transient CCD. Although the clinical significance is still obscure, this phenomenon indicates the cortico-ponto-cerebellar pathway is interrupted due to hyperperfusion, suggesting the development of hyperperfusion syndrome. Careful observation of cerebral hemodynamics after bypass surgery is warranted to avoid hyperperfusion-related complications.

Publication types

  • Case Reports

MeSH terms

  • Cerebellar Diseases / diagnosis
  • Cerebellar Diseases / etiology*
  • Cerebellar Diseases / physiopathology
  • Cerebellum / blood supply
  • Cerebellum / physiopathology
  • Cerebral Revascularization / adverse effects*
  • Cerebral Revascularization / methods
  • Female
  • Frontal Lobe / blood supply
  • Frontal Lobe / physiopathology
  • Humans
  • Hyperemia / etiology
  • Hyperemia / physiopathology
  • Infarction, Middle Cerebral Artery / diagnosis
  • Infarction, Middle Cerebral Artery / physiopathology
  • Infarction, Middle Cerebral Artery / surgery
  • Ischemic Attack, Transient / diagnosis
  • Ischemic Attack, Transient / etiology*
  • Ischemic Attack, Transient / physiopathology
  • Middle Aged
  • Middle Cerebral Artery / diagnostic imaging
  • Middle Cerebral Artery / pathology
  • Moyamoya Disease / diagnosis
  • Moyamoya Disease / physiopathology
  • Moyamoya Disease / surgery*
  • Neural Pathways / blood supply
  • Neural Pathways / physiopathology
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology*
  • Postoperative Complications / physiopathology
  • Radionuclide Imaging
  • Temporal Lobe / blood supply
  • Temporal Lobe / physiopathology