This report describes the instantaneous changes in cerebral blood flow (CBF
), determined by intravascular ultrasound and Doppler, in a patient with ci
rrhosis undergoing placement of a transjugular intrahepatic stent-shunt for
uncontrolled variceal bleeding. Acute changes in CBF were observed during
and after portasystemic shunting, which culminated in cerebral edema and ce
rebral herniation.