Abstracts

Rationale: Cerebral hyperperfusion syndrome (CHS) is a rare life-threatening complication of carotid endarterectomy (CEA) and carotid artery stenting (CAS) for carotid artery stenosis. The incidence varies between 0-3%, depending on the severity of the stenosis, peri-operative hypertension and contralateral carotid stenosis.Methods: The authors retrospectively reviewed the medical records and imaging in a patient with CHS secondary to CEA. This case reports a 53-year-old female patient presented with altered mental status, multiple tonic-clonic seizures, loss of consciousness, and post-ictal confusion. She has a background history of hypertension, hyperlipidemia, diabetes, and recent stroke. She was found to have bilateral carotid stenosis. Her left CEA was peformed three months prior and right CEA was four days prior to her current presentation with seizures. After bilateral CEA, the Imaging showed extensive pathologic process involving primarily the subcortical white matter and overlying cortex, more on the right cerebral hemisphere. On MRI, noted left frontal lobe acute subarachnoid hemorrhage . Other causes of sub arachnoid hemorrhage were ruled out with a negative MRA. CT head showed right frontal and parietal lobes, acute hemorrhage and secondary edema. Transcranial doppler indicated an elevated velocity, consistent with vasospasm of the right anterior cerebral and distal basilar artery. On follow up six weeks later, she reported no recurrent seizures and imaging showed no hemorrhage and a decrease in abnormal signal intensity of the grey and white matter. This was indicative of near complete resolution of hypoperfusion damage, providing more justification for hemorrhage likely secondary to CHS.Results: CHS is a rare complication due to the loss of autoregulation of the cerebrovascular system and increased blood flow status post bilateral CEA. Seizures in this background is rare ranging from 0 -3 %, and occurence of intracerebral hemorrhage is around 0.67 %.Conclusions: This case is reported because of a rare and unique presentation of bilateral CEA.