Hypercapnia-induced cerebral hyperperfusion: An underrecognized clinical entity

Jeffrey Pollock, A. R. Deibler, C. T. Whitlow, H. Tan, R. A. Kraft, J. H. Burdette, J. A. Maldjian

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Background and Purpose: The incidence of cerebral hyperperfusion and hypoperfusion, respectively, resulting from hypercapnia and hypocapnia in hospitalized patients is unknown but is likely underrecognized by radiologists and clinicians without routine performance of quantitative perfusion imaging. Our purpose was to report the clinical and perfusion imaging findings in a series of patients confirmed to have hypercapnic cerebral hyperperfusion and hypocapnic hypoperfusion. Materials and Methods: Conventional cerebral MR imaging examination was supplemented with arterial spin-labeled (ASL) MR perfusion imaging in 45 patients during a 16-month period at a single institution. Patients presented with an indication of altered mental status, metastasis, or suspected stroke. Images were reviewed and correlated with arterial blood gas (ABG) analysis and clinical history. Results: Patients ranged in age from 1.5 to 85 years. No significant acute findings were identified on conventional MR imaging. Patients with hypercapnia showed global hyperperfusion on ASL cerebral blood flow (CBF) maps, respiratory acidosis on ABG, and diffuse air-space bnormalities on same-day chest radiographs. Regression analysis revealed a significant positive linear relationship between cerebral perfusion and the partial pressure of carbon dioxide (pCO 2; β, 4.02; t, 11.03; P 2. Conclusions: With the inception of ASL as a routine perfusion imaging technique, hypercapnic- associated cerebral hyperperfusion will be recognized more frequently and may provide an alternative cause of unexplained neuropsychiatric symptoms in hospitalized patients. In a similar fashion, hypocapnia may account for a subset of patients with normal MR imaging examinations with poor ASL perfusion signal.

Original languageEnglish (US)
Pages (from-to)378-385
Number of pages8
JournalAmerican Journal of Neuroradiology
Volume30
Issue number2
DOIs
StatePublished - Feb 2009
Externally publishedYes

Fingerprint

Hypercapnia
Perfusion Imaging
Cerebrovascular Circulation
Hypocapnia
Respiratory Acidosis
Blood Gas Analysis
Partial Pressure
Carbon Dioxide
Thorax
Perfusion
Gases
Stroke
Air
Regression Analysis
Neoplasm Metastasis
Incidence

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging

Cite this

Pollock, J., Deibler, A. R., Whitlow, C. T., Tan, H., Kraft, R. A., Burdette, J. H., & Maldjian, J. A. (2009). Hypercapnia-induced cerebral hyperperfusion: An underrecognized clinical entity. American Journal of Neuroradiology, 30(2), 378-385. https://doi.org/10.3174/ajnr.A1316

Hypercapnia-induced cerebral hyperperfusion : An underrecognized clinical entity. / Pollock, Jeffrey; Deibler, A. R.; Whitlow, C. T.; Tan, H.; Kraft, R. A.; Burdette, J. H.; Maldjian, J. A.

In: American Journal of Neuroradiology, Vol. 30, No. 2, 02.2009, p. 378-385.

Research output: Contribution to journalArticle

Pollock, J, Deibler, AR, Whitlow, CT, Tan, H, Kraft, RA, Burdette, JH & Maldjian, JA 2009, 'Hypercapnia-induced cerebral hyperperfusion: An underrecognized clinical entity', American Journal of Neuroradiology, vol. 30, no. 2, pp. 378-385. https://doi.org/10.3174/ajnr.A1316
Pollock, Jeffrey ; Deibler, A. R. ; Whitlow, C. T. ; Tan, H. ; Kraft, R. A. ; Burdette, J. H. ; Maldjian, J. A. / Hypercapnia-induced cerebral hyperperfusion : An underrecognized clinical entity. In: American Journal of Neuroradiology. 2009 ; Vol. 30, No. 2. pp. 378-385.
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