Skip to main content
Article thumbnail
Location of Repository

Cerebral misery perfusion diagnosed using hypercapnic blood-oxygenation-level-dependent contrast functional magnetic resonance imaging: a case report

By Adam L. Gordon, Stephen Goode, Olympio D'Souza, Dorothee P. Auer and Sunil K. Munshi


Introduction\ud Cerebral misery perfusion represents a failure of cerebral autoregulation. It is animportant differential diagnosis in post-stroke patients presenting with collapses in the presence of haemodynamically significant cerebrovascular stenosis. This is particularly the case when cortical or internal watershed infarcts are present. When this condition occurs, further investigation should be done immediately.\ud \ud Case presentation\ud A 50-year-old Caucasian man presented with a stroke secondary to complete occlusion of his left internal carotid artery. He went on to suffer recurrent seizures. Neuroimaging demonstrated numerous new watershed-territory cerebral infarcts. No source of arterial thromboembolism was demonstrable. Hypercapnic blood-oxygenation-level-dependent-contrast functional magnetic resonance imaging was used to measure his cerebrovascular reserve capacity. The findings\ud were suggestive of cerebral misery perfusion.\ud \ud Conclusions\ud Blood-oxygenation-level-dependent-contrast functional magnetic resonance imaging allows the inference of cerebral misery perfusion. This procedure is cheaper and more readily available than positron emission tomography imaging, which is the current gold standard diagnostic test. The most evaluated treatment for cerebral misery perfusion is extracranial-intracranial bypass. Although previous trials of this have been unfavourable, the results of new studies involving extracranial-intracranial bypass in high-risk patients identified during cerebral perfusion imaging are awaited.\ud \ud Cerebral misery perfusion is an important and under-recognized condition in which emerging imaging and treatment modalities present the possibility of practical and evidence-based management in the near future. Physicians should thus be aware of this disorder and of recent developments in diagnostic tests that allow its detection

Publisher: Biomed Central
Year: 2010
OAI identifier:
Provided by: Nottingham ePrints

Suggested articles


  1. (2005). Assessing success after cerebral revascularization for ischemia. Skull Base: An Interdisciplinary Approach doi
  2. (2009). Auer DP: Precision of cerebrovascular reactivity assessment with use of different quantification methods for hypercapnia functional MR imaging.
  3. (1981). Castaigne P: Reversal of focal "misery-perfusion syndrome" by extra-intracranial arterial bypass in hemodynamic cerebral ischemia: a case study with 15O positron emission tomography. Stroke
  4. (1991). Cerebral hemodynamics in ischemic cerebrovascular disease.
  5. (2008). Extracranial-intracranial arterial bypass surgery revisited.
  6. (2002). GC: Poststroke Seizures." Arch Neurol
  7. (2004). Heo JH: Hemodynamic changes in limb shaking TIA associated with anterior cerebral artery stenosis. Neurology
  8. (1996). Incidence and clinical characterization of unprovoked seizures in adults: a prospective population-based study. Epilepsia
  9. (2005). JC: The pathophysiology of watershed infarction in internal carotid artery disease: review of cerebral perfusion studies. Stroke
  10. (2005). Ng I: Cerebral revascularisation: where are we now?
  11. (1998). Powers WJ: Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion. JAMA
  12. (2001). RGJ: Reversal of focal misery perfusion after intracranial angioplasty: case report. Neurosurgery
  13. (1987). RW: Cerebral haemodynamic changes after extracranial-intracranial bypass surgery. doi
  14. (1985). The EC/IC Bypass Study Group. Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. Results of an international randomized trial. doi
  15. (2005). Yonas H: Comparative overview of brain perfusion imaging techniques. Stroke

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.