A Case of Diagnostic Uncertainty between Symptomatic Epilepsy and Delayed-onset Hyperperfusion Syndrome after Direct Revascularization for Moyamoya Disease

Key Points

• To explore the diagnostic challenges between symptomatic epilepsy and hyperperfusion syndrome in moyamoya disease post-surgery.
• Case report of a 67-year-old woman
• Utilized 15O-PET and MRI ASL imaging techniques
• Monitored blood flow changes post-revascularization
• Patient developed seizures and aphasia after surgery
• Imaging showed increased blood flow at the surgical site and decreased flow in the contralateral cerebellar hemisphere
• Identified risks of late-onset hyperperfusion syndrome in elderly moyamoya patients