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. 2020 May 15;12(8):788–793. doi: 10.1136/neurintsurg-2019-015621

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© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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(A–D) A patient with left middle artery stenosis presented with multiple strokes at the left cerebral hemispheres. (A) Perfusion CT (cerebral blood flow mapping) reveals a significant decrease in blood flow to the territory of the left middle cerebral artery, including the putamen. (B, C) Catheter angiography performed before (B) and after (C) angioplasty and stenting. The patient complained of severe left-sided headache although blood pressure was controlled at about 120/80 mm Hg after the procedure. Six hours later, a sudden onset of loss of consciousness and intracerebral hemorrhage and hematoventricle were found on CT (D). Cerebral hyperperfusion syndrome complicated by intracranial hemorrhage was diagnosed.