cerebral hyperperfusion syndrome

Q: What is cerebral hyperperfusion syndrome? 


 Answer: After carotid artery stenting or carotid endarterectomy (CEA), patient may experience headache on the ipsilateral side of the procedure, which usually improved in upright posture due to gravity. If it continues, patient may develop seizure or even Intra-Cerebral hemorrhage (ICH). The best prevention is blood pressure control. 

 Mechanism of action: Due to long standing carotid stenosis prior to surgery small vessels in the brain compensate with dilatation. Resolution of carotid stenosis leads to elevated perfusion pressure as there is a chronic loss of cerebral blood flow autoregulation. This again emphasis the need of keeping Systolic 

Blood Pressure less than 140 mm Hg post carotid intervention.

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References:

1. Coutts SB, Hill MD, Hu WY. Hyperperfusion syndrome: toward a stricter definition. Neurosurgery 2003; 53:1053. 

2.  Bouri S, Thapar A, Shalhoub J, et al. Hypertension and the post-carotid endarterectomy cerebral hyperperfusion syndrome. Eur J Vasc Endovasc Surg 2011; 41:229. 

3.  Piepgras DG, Morgan MK, Sundt TM Jr, et al. Intracerebral hemorrhage after carotid endarterectomy. J Neurosurg 1988; 68:532. 

4.  Karapanayiotides T, Meuli R, Devuyst G, et al. Postcarotid endarterectomy hyperperfusion or reperfusion syndrome. Stroke 2005; 36:21.