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2017 ; 2
(2
): 88-93
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Cerebral misery perfusion due to carotid occlusive disease
#MMPMID28959496
Maddula M
; Sprigg N
; Bath PM
; Munshi S
Stroke Vasc Neurol
2017[Jun]; 2
(2
): 88-93
PMID28959496
show ga
PURPOSE: Cerebral misery perfusion (CMP) is a condition where cerebral
autoregulatory capacity is exhausted, and cerebral blood supply in insufficient
to meet metabolic demand. We present an educational review of this important
condition, which has a range of clinical manifestations. METHOD: A non-systematic
review of published literature was undertaken on CMP and major cerebral artery
occlusive disease, using Pubmed and Sciencedirect. FINDINGS: Patients with CMP
may present with strokes in watershed territories, collapses and transient
ischaemic attacks or episodic movements associated with an orthostatic component.
While positron emission tomography is the gold standard investigation for misery
perfusion, advanced MRI is being increasingly used as an alternative
investigation modality. The presence of CMP increases the risk of strokes. In
addition to the devastating effect of stroke, there is accumulating evidence of
impaired cognition and quality of life with carotid occlusive disease (COD) and
misery perfusion. The evidence for revascularisation in the setting of complete
carotid occlusion is weak. Medical management constitutes careful blood pressure
management while addressing other vascular risk factors. DISCUSSION: The evidence
for the management of patients with COD and CMP is discussed, together with
recommendations based on our local experience. In this review, we focus on misery
perfusion due to COD. CONCLUSION: Patients with CMP and COD may present with a
wide-ranging clinical phenotype and therefore to many specialties. Early
identification of patients with misery perfusion may allow appropriate management
and focus on strategies to maintain or improve cerebral blood flow, while
avoiding potentially harmful treatment.
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