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QJM Advance Access originally published online on February 16, 2007
QJM 2007 100(4):239-244; doi:10.1093/qjmed/hcm009
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© The Author 2007. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Cerebral hyperperfusion syndrome following carotid endarterectomy

V. Adhiyaman and S. Alexander

From the Department of Geriatric Medicine, Glan Clwyd District Hospital, Rhyl, UK

Address correspondence to Dr V. Adhiyaman, Department of Geriatric Medicine, Glan Clwyd Hospital, Rhyl, Denbighshire LL18 5UJ. email: vedamurthy.adhiyaman@cd-trust.wales.nhs.uk

The first 150 words of the full text of this article appear below.


   Introduction
 
Extracranial internal carotid artery stenosis accounts for 15–20% of ischaemic strokes and carotid endarterectomy (CEA) is the most frequently performed surgical intervention in stroke prevention.1 The risk of stroke and death associated with the operation has been estimated at about 5.6% (95%CI 4.4–6.9).2 Neurological complications following CEA are usually ischaemic in nature, due to embolization or occlusion of the carotid artery. However, in a small subset of patients, cerebral hyperperfusion or reperfusion causes post-operative neurological dysfunction,3 characterized by ipsilateral headache, focal seizure activity, focal neurological deficit and ipsilateral intracerebral haemorrhage or oedema. Although rare, it can lead to significant morbidity and mortality if not correctly recognized and treated.4


   Haemodynamic changes following CEA
 
The haemodynamic changes following CEA are complex and vary between patients.5–7 The main reason to perform CEA is removal of the source of emboli originating from carotid plaques. However, following successful endarterectomy there is increased blood flow in the ipsilateral carotid artery . . . [Full Text of this Article]


   Hyperperfusion definition
 

   Cerebral hyperperfusion syndrome
 

   Is hyperperfusion always present in symptomatic patients?
 

   Other procedures associated with CHS
 

   Pathophysiology
 
Impaired cerebral autoregulation
Hypertension
Baroreceptor dysfunction
Intra-operative ischaemia
Ischaemia-reperfusion injury

   Pre-operative prediction of CHS
 
Transcranial doppler
Cerebral vasoreactivity (CVR)

   Prevention
 
Blood pressure
When to operate
Free-radical scavengers

   Prognosis
 

   Hyperperfusion or reperfusion syndrome?
 

   Summary
 

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