[Hyperperfusion syndrome after carotid endarterectomy]

Area of Science:

• Neurology
• Vascular Surgery

Background:

• Hyperperfusion syndrome is a rare but serious complication following carotid endarterectomy, characterized by unclear etiology and potentially devastating neurological outcomes.
• It occurs in approximately 3% of cases and can manifest with symptoms ranging from headaches and seizures to coma and death, sometimes involving intracerebral hemorrhage.

Observation:

• A 59-year-old male patient with carotid artery thrombosis and stenosis underwent carotid endarterectomy.
• Postoperatively, the patient developed severe neurological deficits, including an awake coma with quadriparesis and right plegia, indicative of hyperperfusion syndrome.

Findings:

• The patient's condition improved significantly by the 14th postoperative day, with residual deficits requiring further neurological observation.
• This case underscores the clinical presentation of hyperperfusion syndrome, which can occur with or without intracranial hemorrhage.

Implications:

• Active monitoring of intracranial blood flow and systolic blood pressure is crucial for the prevention and management of hyperperfusion syndrome.
• Early recognition and management are essential to mitigate the severe neurological consequences associated with this post-surgical complication.