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Cerebral Flow Dysregulation Encephalopathy Following Carotid Stenting Procedure: Multiparametric CT and EEG
Edoardo Ricci1, Giovanni Furlanis1, Milos Ajčević2
1Clinical Unit of Neurology.
Insights
Cerebral hypoperfusion syndrome (CHS) can mimic stroke. Multiparametric CT and EEG show promise in diagnosing CHS and monitoring its progression after carotid stenting.
Area of Science:
- Neurology
- Radiology
- Neurophysiology
Background:
- Cerebral hypoperfusion syndrome (CHS) presents with neurological symptoms, often following carotid procedures.
- CHS is a rare stroke mimic, complicating hyperacute diagnosis.
- Distinguishing CHS from stroke and other conditions is clinically challenging.
Purpose of the Study:
- To investigate the diagnostic and predictive utility of multiparametric CT and EEG in acute CHS.
- To explore the role of these modalities in differentiating CHS from stroke and stroke mimics.
- To assess the value of serial imaging and EEG in monitoring CHS progression.
Main Methods:
- A case report detailing a 75-year-old male with acute hypoperfusion encephalopathy post-carotid stenting.
- Utilized multiparametric CT (NECT, CTA, CTP) and electroencephalogram (EEG) for acute assessment.
- Performed follow-up NECT, CTP, and EEG at 24 and 72 hours.
Main Results:
- Demonstrated the utility of multiparametric CT and EEG in the acute diagnosis of CHS.
- Highlighted the ability of these combined methods to differentiate CHS from ischemic events, status epilepticus, and stroke mimics.
- Showcased the value of repeated testing in tracking clinical progression.
Conclusions:
- Multiparametric CT combined with EEG and clinical evaluation aids in emergency differential diagnosis of CHS.
- Serial application of these diagnostic tools provides an innovative method for monitoring CHS.
- This approach supports the hypothesis of multiparametric CT and EEG's role in managing CHS.
Introduction:
Cerebral hypoperfusion syndrome (CHS) involves a range of neurological symptoms originally recognized as a complication of carotid endarterectomy but also observed after carotid artery stenting. CHS is a rare cause of stroke mimic, posing a challenging differential diagnosis, especially in the hyperacute phase.
Case Presentation:
In this case report, we investigate the potential diagnostic and predictive roles in the acute phase through a novel approach using multiparametric CT [including non-enhanced CT (NECT), single-phase CT angiography (CTA), perfusion CT (CTP)] and electroencephalogram (EEG) in a 75-year-old male with acute hypoperfusion encephalopathy/cerebral flow dysregulation after carotid stenting. Follow-up imaging was performed with NECT, CTP, and EEG at 24 and 72 hours.
Conclusions:
This clinical case supports the hypothesis that multiparametric CT, combined with EEG and clinical evaluation, may be useful in the differential diagnosis between CHS, ischemic events, status epilepticus, and stroke mimics in the emergency setting. Moreover, the repeated use of these tests offers a valuable and innovative approach to monitoring the clinical progression of this condition.
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