Stroke, Vol 12, 454-459, Copyright © 1981 by American Heart Association
JC Baron, MG Bousser, A Rey, A Guillard, D Comar and P Castaigne
Tomographic images of cerebral blood flow (CBF) and oxygen extraction
fraction (OEF) using the 15O 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 the
middle cerebral artery where CBF was decreased and OEF increased
("misery-perfusion syndrome" as opposed to "luxury- perfusion syndrome").
These abnormalities were most marked in the parieto-occipital watershed
area. After left superficial temporal to middle cerebral artery
anastomosis, the clinical attacks ceased and a repeat study did not
demonstrate the previous CBF and OEF abnormalities. This suggests that this
pattern of abnormalities indicates potential viable tissue. The concept of
"misery-perfusion" may be of some importance in the pathophysiological
mechanisms of hemodynamic cerebral ischemia and serve as a rational basis
for revascularization procedures.
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