Cortical non-aneurysmal subarachnoid hemorrhage post-carotid endarterectomy: a case report and literature review

详细信息    查看全文

• 作者：Gopiga Thanabalasundaram ; Silvia Hern谩ndez-Dur谩n ; Thabele Leslie-Mazwi…
• 关键词：Non ; aneurysmal subarachnoid hemorrhage ; Carotid endarterectomy ; Carotid stenosis ; Reperfusion injury
• 刊名：SpringerPlus
• 出版年：2013
• 出版时间：December 2013
• 年：2013
• 卷：2
• 期：1
• 全文大小：228KB
• 参考文献：Bodenant M, Leys D, Lucas C: Isolated subarachnoidal hemorrhage following carotid endarterectomy. Case Rep Neurol 2010,2(2):80鈥?4.CrossRef
  Bouri S, Thapar A, Shalhoub J, Jayasooriya G, Fernando A, Franklin I, Davies A: Hypertension and the post-carotid endarterectomy cerebral hyperperfusion syndrome. Eur J Vasc Endovasc Surg 2011, 41:229鈥?37.CrossRef
  Connolly E, Rabinstein A, Carhuapoma J, Derdeyn C, Dion J, Higashida R, et al.: Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke 2012,43(6):1711鈥?737.CrossRef
  Dalton M: Subarachnoid hemorrhage after carotid endarterectomy. J Vasc Surg 1992,16(5):799.CrossRef
  Lieb M, Shah U, Hines G: Cerebral hyperperfusion syndrome after carotid intervention: a review. Cardiol Rev 2012, 20:84鈥?9.
  Maas MB, Kwolek CJ, Hirsch JA, Jaff MR, Rordorf GA: Clinical risk predictors for cerebral hyperperfusion syndrome after carotid endarterectomy. J Neurol Neurosurg Psychiatry 2013, 84:569鈥?72. doi:10.1136/jnnp-2012鈥?03659CrossRef
  McDonald R, Cloft H, Kallmes D: Intracranial hemorrhage is much more common after carotid stenting than after endarterectomy: evidence from the national inpatient sample. Stroke 2011, 42:2782鈥?787.CrossRef
  Moulakakis K, Mylonas S, Sfyroeras G, Andrikopoulos V: Hyperperfusion syndrome after carotid revascularization. J Vasc Surg 2009, 49:1060鈥?068.CrossRef
  Ogasawara K, Sakai N, Kuroiwa T, Hosoda K, Iihara K, Toyoda K, et al.: Intracranial hemorrhage associated with cerebral hyperperfusion syndrome following carotid endarterectomy and carotid artery stenting: retrospective review of 4494 patients. J Neurosurg 2007, 107:1130鈥?136.CrossRef
  Pyysalo L, Niskakangas T, Keski-Nisula L, K盲h盲r盲 V, 脰hman J: Long term outcome after subarachnoid haemorrhage of unknown aetiology. J Neurol Neurosurg Pyschiatry 2011,82(11):1264鈥?266.CrossRef
  van Mook W, Rennenberg R, Schurink G, van Oostenbrugge R, Mess W, Hofman P, de Leeuw P: Cerebral hyperperfusion syndrome. Lancet Neurol 2005, 4:877鈥?88.CrossRef
  Wellman G, Koide M: Impact of subarachnoid hemorrhage on parenchymal arteriolar function. Acta Neurochir Suppl 2013, 115:173鈥?77.
  Wu T, Anderson N, Pa B: Neurological complications of carotid revascularization. J Neurol Neurosurg Psychiatry 2012, 83:543鈥?50.CrossRef
  
• 作者单位：Gopiga Thanabalasundaram (5) (5) (6)
  Silvia Hern谩ndez-Dur谩n (5) (6) (6)
  Thabele Leslie-Mazwi (6)
  Christopher S Ogilvy (5) (6)
  
  5. University College London Medical School, Gower Street, London, WC1E 6BT, UK
  6. Universidad de Costa Rica, Ciudad Universitaria Rodrigo Facio, San Pedro de Montes de Oca, San Jos茅, Costa Rica
  
• 刊物类别：Science, general;
• 刊物主题：Science, general;
• 出版者：Springer International Publishing
• ISSN：2193-1801

文摘

Cerebral hyperperfusion syndrome is a well-recognized and potentially fatal complication of carotid revascularization. However, the occurrence of non-aneurysmal subarachnoid hemorrhage as a manifestation of cerebral hyperperfusion syndrome post-carotid endarterectomy is uncommon. We report a case of a patient who presented with headache following carotid endarterectomy for a critically occluded common carotid artery. This progressed to deteriorating consciousness and seizures. Investigations revealed a left cortical non-aneurysmal subarachnoid hemorrhage. Non-aneurysmal subarachnoid hemorrhage is a rare post-operative complication of carotid endarterectomy. Immediate management with aggressive blood pressure control is key to prevent permanent neurological deficits. Cerebral hyperperfusion syndrome (CHS) after carotid revascularization procedures is an uncommon and potentially fatal complication. Pathophysiologically it is attributed to impaired autoregulatory mechanisms and results in disruption of cerebral hemodynamics with increased regional cerebral blood flow (Cardiol Rev 20:84鈥?9, 2012; J Vasc Surg 49:1060鈥?068, 2009). The condition is characterized by throbbing ipsilateral frontotemporal or periorbital headache. Other symptoms include vomiting, confusion, macular edema, focal motor seizures with frequent secondary generalization, focal neurological deficits, and intraparenchymal or subarachnoid hemorrhage (SAH) (Lancet Neurol 4:877鈥?88, 2005). The incidence of CHS varies from 0.2% to 18.9% after carotid endarterectomy (CEA), with a typical reported incidence of less than 3% in larger studies (Cardiol Rev 20:84鈥?9, 2012; Neurosurg 107:1130鈥?136, 2007). Uncontrolled hypertension, an arterially isolated cerebral hemisphere, and contralateral carotid occlusion are the main risk factors (Lancet Neurol 4:877鈥?88, 2005; J Neurol Neurosurg Psychiatry 83:543鈥?50, 2012). We present a case of non-aneurysmal SAH after CEA, with focus on its presentation, risk factors, and management. Keywords Non-aneurysmal subarachnoid hemorrhage Carotid endarterectomy Carotid stenosis Reperfusion injury