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Complications of carotid endarterectomy
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
Laura T. Boitano, Mark F. Conrad
Cerebral hyperperfusion syndrome results from an “unexpected increase in cerebral blood flow > 100%, potentially leading to cerebral hemorrhage.”25 The mechanism by which this occurs is related to chronic ischemia resulting in maximal dilation of cerebral vessels and lack of autoregulation followed by normal or elevated blood flow after carotid revascularization. This results in cerebral edema and potentially hemorrhage.25–28 Though a rare complication after CEA (0–3% in the literature), it is associated with high mortality of up to 50%.26,27 The syndrome typically occurs as a delayed perioperative complication on postoperative day 3 to 6. Clinical manifestations include headache, which is ipsilateral to the CEA, focal neurologic deficits, cerebral edema, brain hemorrhage, and seizures.26–28 In its early stages, the edema is reversible so early recognition is critical to prevention of catastrophic consequences.
Vascular Surgery
Published in Elizabeth Combeer, The Final FRCA Short Answer Questions, 2019
Cerebral hyperperfusion syndrome, occurs from immediately postoperatively until a month later. Chronic hypoperfusion results in areas of impaired autoregulation. Increased microvascular permeability occurs on reperfusion of previously underperfused areas of brain, increasing vulnerability to oedema: ischaemia-reperfusion injury. Extreme hypertension resulting from impaired carotid baroreceptor function postoperatively, in combination with the previous changes, may result in oedema and haemorrhage. Result: hypertensive encephalopathy, severe headache, variable neurological deficits, seizures, cerebral oedema, cerebral haemorrhage.
Headache associated with vascular disease: migraine and stroke
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
The third type of headache is part of the ‘cerebral hyperperfusion syndrome’ that mainly occurs after correction of a veiy high-grade stenosis in patients with chronic cerebral ischemia.108,111–115 It is a severe, unilateral, throbbing pain that begins after a mean latent interval of 3 days after surgery. It often precedes the onset of seizures, contralateral focal deficits, and an increase in systemic blood pressure on around the seventh postoperative day.25
Brain ultrasound for diagnosis and prognosis in the neurological intensive care unit: a mini review for current development
Published in Neurological Research, 2019
Haomeng Zhu, Xiaokun Geng, Gary B. Rajah, Paul Fu, Huishan Du
TCD has been widely used in the clinical prediction of cerebral hyperperfusion syndrome occurring post-carotid endarterectomy and carotid stent placement [15,16]. Real-time collateral circulation monitoring is possible during stroke interventions and may have wide-ranging applications to therapies for arteriovenous malformations. Real-time monitoring with TCD can also help practitioners identify areas of possible ischemia during endovascular and open procedures [17,18].