Affiliations: [a] Stroke Unit, Department of Neurology, Brugmann University Hospital, Brussels, Belgium | [b] Nuclear Medicine Department, Brugmann University Hospital, Brussels, Belgium | [c] Second Department of Neurology, University of Athens, School of Medicine, “Attikon” University Hospital, Athens, Greece | [d] Third Department of Surgery, School of Medicine, University of Athens, Athens, Greece | [e] International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic
Correspondence:
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Correspondence to: Dr. Apostolos Safouris, Place Van Gehuchten 4, 1020 Bruxelles, Belgium. Tel.: +32 4773281; Fax: +32 4773467; E-mail: safouris@yahoo.com.
Abstract: A 62-year-old patient presented with persistent cognitive deficits 3 months after a right temporal ischemic stroke due to ipsilateral carotid occlusion. Work-up disclosed hemodynamically significant contralateral carotid artery stenosis and left subclavian steal phenomenon. Brain SPECT imaging revealed bihemispheric chronic brain hypoperfusion that substantially improved on repeat imaging when the subclavian steal was temporarily diminished by inflating a cuff around the left arm. Carotid endarterectomy of the asymptomatic carotid stenosis substantially ameliorated bihemispheric brain perfusion and reversed cognitive impairment. This case highlights that multi-vessel, extracranial atherosclerotic disease may cause chronic diffuse brain hypoperfusion that can be associated with cognitive impairment.
