PMC4533377_01
Magnetic resonance imaging study of the fluid-attenuated inversion recovery (upper) and T2-weighted image (lower). A: Images on admission. High signal is present in the territory perfused by the anterior cerebral artery (ACA). B: Postoperative images obtained 7 days after surgery demonstrate disappearance of the high signal. No new ischemic signs are present. C: 3 months after surgery. Infarcted area in the ACA territory has transformed to atrophy.
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F1
Magnetic resonance imaging (MRI) demonstrated cerebral infarction at the medial side of the left frontal lobe in the territory perfused by the ACA (Fig. 1A). MRI (Fig. 3C). MRI studies performed 7 days after surgery demonstrated no additional ischemic lesions (Fig. 1C).
Axial image of magnetic resonance angiogram. A: 3 months before surgery, the left middle cerebral artery (MCA) is patent. B: Preoperative image reveals immediate progression of the stenosis of the left M1 portion (arrow). C: Postoperative image obtained 7 days after surgery. Superficial temporal artery (STA)-MCA double bypass were patent, and STA did not show very high signal (arrowhead).
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F2
Magnetic resonance angiography (MRA) revealed stenosis of the terminal portion of the left internal carotid artery that had not been detected on similar studies performed 3 months prior (Fig. 2A, B).
Cerebral hemodynamic studies with resting states of N-isopropyl-p-[I123] iodoamphetamine single-photon emission computed tomography images. A: 2 years before surgery. B: Preoperative images show poor perfusion in the right fronto-temporal lobe (arrow). C: Postoperative images obtained 3 days after surgery demonstrate a wide increase in the perfusion of the left hemisphere, with the exception of the area of infarction.
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F3
N-isopropyl-p-[I123] iodoamphetamine single-photon emission computed tomography (IMP-SPECT) showed markedly decreased uptake in the left fronto-temporal region that was not detected previously (Fig. 3A, B). MRI (Fig. 3C). MRI studies performed 7 days after surgery demonstrated no additional ischemic lesions (Fig. 1C).
Operative photographs. A: View after the indirect bypass surgery. B: View of the superficial temporal artery-middle cerebral artery double anastomoses sites on the left cerebral convexity.
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F4
Finally, EGDMS was performed (Fig. 4).