PMC4533386_01
Diffusion-weighted imaging performed at admission (left) showed an acute cerebral infarction in the left occipital lobe, and magnetic resonance angiography (right) indicated left posterior cerebral artery occlusion.
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F1
Magnetic resonance angiography (MRA) showed occlusion of the left posterior cerebral artery (Fig. 1).
MRI performed on day 30 of hospitalization. Upper section: DWI revealed a diffuse acute cerebral infarction (arrowhead). Lower section: FLAIR images showed a small amount of SAH along the left central sulcus (arrow). DWI: diffusion-weighted imaging, FLAIR: fluid attenuated inversion recovery, MRI: magnetic resonance imaging, SAH: subarachnoid hemorrhage.
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F2
Magnetic resonance imaging (MRI) revealed multiple new cerebral infarctions in the region of the left middle cerebral artery (MCA), and a small amount of subarachnoid hemorrhage (SAH; Fig. 2).
Angiography was performed on day 30 of hospitalization. An irregular 4-mm aneurysm was found at the bifurcation of the left parietal artery (arrow, left: anteroposterior view; right: lateral view).
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Cerebral angiography demonstrated an irregular aneurysm 4 mm in diameter at the bifurcation of the left parietal artery (Fig. 3), and she was diagnosed with a mycotic aneurysm.
a: Intraoperative photograph showing a mycotic aneurysm (asterisk) and the posterior parietal artery (arrowhead). The aneurysm was reddish-brown, and the posterior parietal artery measured approximately 1 mm in diameter. b: The STA was anastomosed to the posterior parietal artery. STA: superficial temporal artery.
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The STA was anastomosed to the posterior parietal artery, which measured approximately 1 mm in diameter, and the mycotic aneurysm was resected after parent vessel ligation (Fig. 4).
a: MRA performed 2 days after surgery revealed left MCA dilation, and N-isopropyl-p-[123I]-iodoamphetamine (123I-IMP) SPECT showed hyperperfusion in the left temporal and parietal lobes. b: MRA performed 9 days after surgery showed that the dilated MCA was recovering its original diameter; the hyperperfusion detected on 123I-IMP SPECT resolved gradually. c: MRA performed 1 month after surgery showed no dilation of the left MCA, and 123I-IMP SPECT showed resolution of the hyper- and hypoperfusion in the left temporal and parietal lobes, which had previously shown hyperperfusion. MCA: middle cerebral artery, MRA: magnetic resonance angiography, SPECT: single-photon emission computed tomography.
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These findings led to the diagnosis of HPS (Fig. 5a). The hyperperfusion detected on 123I-IMP SPECT resolved gradually, but blood flow in the left temporal and parietal lobes had decreased (Fig. 5b, c). 123I-IMP SPECT performed 3 months after surgery revealed little change, and MRI showed no new cerebral infarctions.