• brain ischaemia
• cerebral revascularisation

The extracranial-intracranial (EC-IC) arterial bypass study has been criticised for failing to select for patients with chronic haemodynamic insufficiency and for revascularisation with low flow grafts, which may augment perfusion inadequately.¹ We report a case of EC-IC bypass in a patient with severe intracranial carotid stenosis and compromised cerebrovascular reserve, which was complicated by intraoperative hyperperfusion syndrome. Hyperperfusion syndrome as a result of EC-IC bypass is not well documented and its occurrence directly after bypass has not been reported before. We discuss the pathophysiology and prophylactic measures of this complication, with special attention to the nature of the bypass performed.

A 48 year old right handed woman presented with a four month history of recurrent transient ischaemic attacks characterised by left sided symptoms of perioral paraesthesia, hand numbness, and upper extremity weakness (grade 4/5). The attacks were refractory to treatment with ticlid, a platelet aggregation inhibitor, and at the time of admission to hospital she was having several episodes daily, each lasting up to 15 minutes. She was therapeutically heparinised, her blood pressure was augmented to 150–180 mm Hg with intravenous vasopressors, and florinef treatment was begun to expand her vascular volume. The transient ischaemic attacks persisted unabated despite three weeks of this regimen in the intensive care unit.

Preoperative T2 weighted magnetic resonance …