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Early recognition of cerebral hyperperfusion syndrome after carotid stenting--a case report
1Department of Radiology, Veterans General Hospital-Taipei, Taipei, Taiwan. eric.tpe@yahoo.com.tw
Insights
Sentinel headache may signal cerebral hyperperfusion injury after carotid stenting, a rare but serious complication. Early recognition and management are crucial for patients experiencing this symptom post-procedure.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Cerebral hyperperfusion syndrome is a known complication after carotid endarterectomy.
- Reports of cerebral hyperperfusion injury following internal carotid artery angioplasty and stenting are infrequent.
Observation:
- A 76-year-old hypertensive male presented with a history of ischemic stroke.
- He underwent successful percutaneous transluminal stenting of the left internal carotid artery (ICA) for 60% stenosis.
- Two hours post-procedure, the patient experienced sudden deterioration with a precipitating migranous headache and moderately elevated blood pressure.
Findings:
- Computed tomography (CT) revealed extensive intracerebral hemorrhage, leading to the patient's death five days later.
- Sentinel headache, particularly in hypertensive patients, may be an early indicator of cerebral hyperperfusion injury after carotid stenting.
Implications:
- Early recognition of sentinel headache in patients undergoing carotid angioplasty is critical.
- Intensive investigation for cerebral hyperperfusion injury and prompt management are warranted in such cases.
Abstract:
The hyperperfusion syndrome is a recognized complication of carotid endarterectomy. Reports of cerebral hyperperfusion injury following internal carotid artery angioplasty and stenting are few We report a case of 76-year-old hypertensive man who was admitted to our hospital for assessment 2 years after experiencing an ischemic stroke of right hemisphere. Angiography confirmed 60% stenosis of left internal carotid artery (ICA). Percutaneous transluminal stenting of left internal carotid artery was performed without any immediate complications. Two hours after the procedure, the patient suddenly deteriorated. Computed tomography (CT) of the brain revealed extensive intracerebral hemorrhage and he died 5 days later. There was precipitating migranous headache, and his blood pressure was moderately elevated at the time of deterioration. Sentinel headache could solely indicate the early sign of hyperperfusion injury after carotid stenting, especially in the presence of arterial hypertension. Patients with sentinel headache after angioplasty should be recognized early and they deserve intensive study for other features of cerebral hyperperfusion injury and prompt early management.