Cerebral Hyperperfusion Syndrome Following Carotid Endarterectomy: A Case Report

Abstract

Cerebral hyperperfusion syndrome (CHS) is a rare but potentially life-threatening complication of carotid revascularization. A 73-year-old woman presented with convulsions three days after left carotid endarterectomy for a reported 97% stenosis. She described blurred vision, vertigo and facial paralysis. Contrast-enhanced CT demonstrated left hemispheric hypervascularization, and MRI showed left frontoparietal and thalamic vasogenic edema. Her condition deteriorated to coma, prompting intensive care admission. Corticosteroid administration was reported during her admission. She recovered, was discharged two days later and had no residual deficits at one-month follow-up. This temporal course does not establish an independent treatment effect of corticosteroids. The case illustrates the need to consider CHS in patients with neurological deterioration after carotid endarterectomy. Evidence on risks and timing after carotid artery stenting should be distinguished from evidence after endarterectomy.