Reversal of focal "misery-perfusion syndrome" by extra-intracranial arterial bypass in hemodynamic cerebral ischemia. A case study with 15O positron emission tomography.

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Abstract
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 O2 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 pattern of abnormalities may indicate 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.