Abstract
We report 2 cases with occlusive cerebrovascular disease in which superficial temporal artery-middle cerebral artery (STA-MCA) bypass apparently improved the dementia. The first patient, a 65-year-old male, complained of transient weakness of the left extremities and was of dementia with the total intelligence quotient (IQ) of 74. The neuroimages showed occlusion of the internal carotid artery and watershed cerebral infarction on the right side. Single photon emission computed tomography (SPECT) revealed decreased cerebral blood flow (CBF) at rest and impaired acetazolamide reactivity in the affected hemisphere. After the right STA-MCA anastomosis, the cognitive function improved gradually in accordance with increasing CBF. The total IQ recovered to 84 in eight months after the operation. The second patient was a 61-year-old female complaining of transient right motor weakness and aphasia. Her total IQ was decreased to 76 without no infarction on CT scan. Angiography demonstrated left MCA occlusion, and SPECT study showed decreased resting CBF and impaired acetazolamide reactivity in the left cerebral hemisphere. After the left STA-MCA anastomosis, her clinical symptoms and cognitive function improved markedly in accordance with increasing CBF. The total IQ increased to 84 in four months after the operation. The results of our cases and other reports suggest that dementia due to hemodynamic insufficiency would be treatable if surgical revascularization is performed in early phase of the condition.
