gms | German Medical Science

Objective: The occurrence of hyperperfusion syndrome after superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis for Moyamoya disease (MMD) is well known and described in the literature. A critical coexistence of hyper- and hypoperfusion syndrome after revascularisation surgery is very rare.

Methods: A 57-year-old woman was afflicted with recurrent TIAs (transient ischemic attacks) for 4 years. She developed a stroke in April 2011 with hemiparesis on the left, motor aphasia with left-handedness and facial palsy. A bilateral stenosis of the middle cerebral artery (MCA) with suspicion of moyamoya syndrome was found and so a revascularisation surgery on the symptomatic side was indicated. During the were no complications, but in the course, the woman developed again neurological deficits in blood pressure fluctuations, so that a strict blood pressure control (130mmHg) was required to avoid hyper- or hypoperfusion.

Results: In a systolic blood pressure of above or below 130 mmHg the patient developed a hemiparesis and motor aphasia. Only by setting very close blood pressure limits, there was an almost complete regression of neurological deficits.

Conclusion: To prevent neurological deficits after STA-MCA (superficial temporal artery-middle cerebral artery) anastomosis the knowledge of hyperperfusion and hypoperfusion syndrom with al facets is required, since a very accurate blood pressure control deficits can be solved or even avoided.