A Case of Cerebral Hyperperfusion Hemorrhage after Intracranial Stent Implantation in the Middle Cerebral Artery

脑高灌注综合征(CHS)是脑血管重建术后罕见的并发症。它表现为同侧头痛、呕吐、癫痫发作和脑出血。既往报道颈动脉内膜切除术和支架植入术后高灌注综合征较常见，颅内支架植入术后出现的高灌注综合征则鲜有报道。一名77岁男性患者以被人发现言语不能3小时余入院。入院接受了脑血管数字减影血管造影(DSA)检查，结果显示左侧大脑中动脉M1段闭塞。急诊行左侧大脑中动脉M1段球囊扩张 + NEUROFORMEZ 4.0 mm × 20 mm支架植入术，术后造影见左侧大脑中动脉血流通畅，远端血管显影良好。4天后，患者突发意识不清加重伴双侧瞳孔不等大，左侧瞳孔3.5 mm，右侧瞳孔3.0 mm。头颅CT显示左侧基底节区及左侧额颞顶叶脑出血，量约170 mL，并脑疝形成。Cerebral hyperperfusion syndrome (CHS) is a rare complication after cerebrovascular reconstruction surgery. It is manifested as ipsilateral headache, vomiting, epileptic seizures, and cerebral hemorrhage. Hyperperfusion syndrome was relatively common after extracranial carotid endarterectomy and stent implantation in the past, while hyperperfusion syndrome after intracranial stent implantation has been rarely reported. A 77-year-old male patient was admitted to the hospital more than 3 hours after being found unable to speak. The patient underwent digital subtraction angiography (DSA) of the cerebral vessels after admission, and the results showed occlusion of the M1 segment of the left middle cerebral artery. Emergency balloon dilation + NEUROFORMEZ 4.0 mm × 20 mm stent implantation in the M1 segment of the left middle cerebral artery was performed. Postoperative angiography showed smooth blood flow in the left middle cerebral artery and good visualization of the distal vessels. Four days later, the patient suddenly worsened in terms of clouded consciousness accompanied by unequal bilateral pupils (the left pupil was 3.5 mm and the right pupil was 3.0 mm). Head CT showed cerebral hemorrhage in the left basal ganglia region and the left frontal, temporal, and parietal lobes, with a volume of approximately 170 mL, and herniation formation.