Cerebral hyperperfusion syndrome is a consequence of cerebral hyperemia and can lead to neuronal disfunction, cerebral edema, and/or intracerebral hemorrhage. Symptoms vary depending on the vascular bed involved, and the syndrome can be fatal in some cases. Cerebral hyperperfusion is thought to result from a failure of autoregulation. It usually occurs in the setting of hypertension (i.e., excessive cerebral perfusion pressure) following restoration of cerebral blood flow into a previously hypoperfused (and chronically vasodilated) region. This can occur following such procedures as internal carotid endarterectomy, extracranial to intracranial bypass, and/or cerebral artery angioplasty/stenting. Optimal blood pressure following flow restoration is individualized based on the patient’s baseline blood pressure, the nature of the cerebrovascular disease and the corrective procedure. Quantitative determination of CBF in various brain regions would be required to optimize cerebral perfusion pressure in a precise and individualized manner. Continuous point-of-care cerebral perfusion monitoring of multiple brain regions would be ideal. CT, MR, and TCD technologies have been utilized at some centers.
Chui J, Manninen P, Sacho RH, Venkatraghavan L. Anesthetic management of patients undergoing intracranial bypass procedures. Anesth Analg. 2015 Jan;120(1):193-203