J Korean Neurosurg Soc.  2014 Nov;56(5):441-443. 10.3340/jkns.2014.56.5.441.

Delayed Cerebral Hyperperfusion Syndrome Three Weeks after Carotid Artery Stenting Presenting as Status Epilepticus

• Oh SI
• Lee SJ
• Lee YJ
• Kim HJ

• KMID: 2018106
• DOI: http://doi.org/10.3340/jkns.2014.56.5.441

Abstract

Cerebral hyperperfusion syndrome (CHS) is increasingly recognized as an uncommon, but serious, complication subsequent to carotid artery stenting (CAS) and carotid endarterectomy (CEA). The onset of CHS generally occurs within two weeks of CEA and CAS, and a delay in the onset of CHS of over one week after CAS is quite rare. We describe a patient who developed CHS three weeks after CAS with status epilepticus.

Keyword

Cerebral hyperperfusion syndrome; Carotid artery stenting; Carotid artery stenosis; Status epilepticus

MeSH Terms

Carotid Arteries*
Carotid Stenosis
Endarterectomy, Carotid
Humans
Status Epilepticus*
Stents*

Figure

• 

  Fig. 1 Pre-stenting cerebral angiography shows the narrow left proximal internal carotid artery (ICA) (A) and post-stenting cerebral angiography shows the widened left ICA stenosis (B).

• 

  Fig. 2 Postprocedural magnetic resonance imaging three weeks (A, B, and C) and five weeks (D, E, and F) after carotid artery stenting. The signal abnormality on the fluid-attenuated inversion recovery image at three weeks (A) was markedly improved at five weeks (D). The diffusion weighted images and apparent diffusion coefficient map images shown were improved compared to the previous MR images.

• 

  Fig. 3 Perfusion CT shows that cerebral blood volume at the time of the development of the cerebral hyperperfusion syndrome (CHS) (A) is higher than at 24 days after CHS with improvement (B) in both hemispheres.

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