[Hyperperfusion syndrome following carotid revascularization--a subject for the family doctor]

Hyperperfusion following revascularization of ischemic organs is a well-known phenomenon. It is usually self-limiting and may corroborate success. In the brain, however, hyperperfusion may cause catastrophic consequences. Symptoms range from seizures and neurological deficits to intracerebral haemorrhage. It should be taken into consideration that symptoms may occur between days and even several weeks after revascularization. Therefore in times of "fast-track-rehabilitation" it is the family doctor who sees the patient's complication first. He should be familiar with the hyperperfusion syndrome. Most important are the questions, to what extent the patient at "high-risk" can be identified preoperatively, whether the development of hyperperfusion syndrome can be predicted in the postoperative period and furthermore, how the magnitude of syndrome can be influenced. By analyzing two impressive cases, critical and striking findings are isolated and discussed with the comprehensive literature. It can be seen that nearly all the findings which are known as "high-risk-factors" are inconsistently presented in the literature. Their predictive value seems to be extremely questionable. Consensus, however, consists in that the extent of the symptoms may be limited by intensive blood pressure control, even if the patient's pressure is "normal".