Reversal of Focal "Misery-Perfusion Syndrome" By Extra-Intracranial Arterial Bypass in Hemodynamic Cerebral Ischemia

Tomogrephic images of cerebral blood flow (CBF) and oxygen extraction fraction (OEF) using the O continuous inhalation technique, and positron emission tomography, were obtained from a patient with cerebral ischemia distal to an occluded left internal carotid artery. There was a focal mismatch between CBF and oxygen metabolism in the brain supplied by tbe middle cerebral artery where CBF was decreased and OEF increased ("misery-perfusion syndrome" as opposed to "luxury-perfusioa syndrome"). These abnormalities were most marked in tbe parieto-ocdpital watershed area. After left superficial temporal to middle cerebral artery anastomosis, the clinical attacks ceased and a repeat study did not demonstrate tbe prerious CBF and OEF abnormalities. This suggests that this pattern of abnormalities indicates potential liable tissue. The concept of "mlsery-perfuslon" may be of some importance In tbe patbophysiological mechanisms of hemodynamic cerebral ischemia and serve as a rational basis for rerascularization procedures. Stroke, Vol 12, No 4, 1981