Abstract
A case of cerebral embolism, showing marked capillary blush on the right perforating arteries of the middle cerebral artery (MCA) is reported.
A hypertensive 57-year-old man experienced weakness in his left upper and lower extremities with headache in the early morning. He was admitted to the hospital. Physical examination revealed atrial fibrillation, slight dysarthria and left hemiparesis with accelerated deep tendon reflexes and positive pathological reflexes. Brain CT revealed a low density area on the right basal ganglia and internal capsule. Cerebral embolism of cardiac origin was diagnosed clinically. Angiography, taken 12 hours after onset, revealed marked capillary blush on the perforating arteries of the MCA. Early venous filling of the thalamostriate vein and the Rosenthal vein in the arterial phase was noted as well as occlusion of the right MCA branches with retrograde filling through the leptomeningeal anastomosis from the anterior and posterior cerebral arteries. These neurological deficits improved gradually 8 days later and angiogram, studied 33 days after onset, was almost normal.
In general, capillary blush and early venous filling are frequently seen after reopening of ischemic regions caused by cerebral embolism. Capillary blush was considered as hyperemia, while early venous filling as hyperperfusion. The former was especially noted over the cortical region, but rare in the deep areas where brain edema was induced by infarction. In this case, however, ischemia was mild. Therefore, it appeared that dilatation of the capillary lumen resulted in hyperemia after reperfusion in addition to hyperperfusion due to vasoparalysis of arterioles.
