Scholarly Research Exchange

Scholarly Research Exchange / 2009 / Article

Case Report | Open Access

Volume 2009 |Article ID 108498 | 2 pages | https://doi.org/10.3814/2009/108498

Atypical Hyperperfusion Encephalopathy in Post-Carotid Stenting

Received22 Jul 2008
Revised13 Apr 2009
Accepted22 Apr 2009
Published02 Jun 2009

Abstract

Hyperperfusion encephalopathy (HPE) is a condition due to increased perfusion of the brain which is clinically characterized by headache, seizures, and other neurologic signs associated with increased (or not) systemic blood pressures and edema in the subcortical white matter (predominantly in the occipital lobe). Patients with critical carotid stenosis treated with endarterectomy or carotid artery stenting may develop a HPE syndrome of the ipsilateral hemisphere which closely resembles the unilateral HPE and that usually involves the vascular area subjected ipsilaterally to the carotid stenosis. We present here a case of a 62-year-old woman who developed atypical hyperperfusion syndrome after a carotid stenting for high-grade carotid artery stenosis. In our patient, the HPE involved bilaterally both hemispheres, even though the treatment of the carotid stenosis was unilaterally. Some authors have hypothesized that a high dose of contrast, in combination with an unidentified personal vulnerability, may result in the rupture of the blood-brain barrier, carrying the CA into the cerebral parenchyma (both hemispheres), leading to the encephalopathy. The course and prognosis of HPE in post-carotid stenting are excellent with conservative treatment and full recovery usually occurs within 24 to 48 hours.

References

  1. R. B. Schwartz, “Hyperperfusion encephalopathies: hypertensive encephalopathy and related conditions,” Neurologist, vol. 8, no. 1, pp. 22–34, 2002. View at: Publisher Site | Google Scholar
  2. S. Macdonald, “Brain injury secondary to carotid intervention,” Journal of Endovascular Therapy, vol. 14, no. 2, pp. 219–231, 2007. View at: Google Scholar
  3. J. G. Heckmann, B. Neundörfer, C. J. G. Lang, and D. Werner, “Hyperdensity of cortex with a swollen hemisphere: what happened?,” Archives of Neurology, vol. 59, no. 1, pp. 149–150, 2002. View at: Publisher Site | Google Scholar
  4. G. Dangas, L. H. Monsein, R. Laureno et al., “Transient contrast encephalopathy after carotid artery stenting,” Journal of Endovascular Therapy, vol. 8, no. 2, pp. 111–113, 2001. View at: Publisher Site | Google Scholar
  5. A. A. Penn, D. F. Schomer, and G. K. Steinberg, “Imaging studies of cerebral hyperperfusion after carotid endarterectomy: case report,” Journal of Neurosurgery, vol. 83, no. 1, pp. 133–137, 1995. View at: Google Scholar
  6. E. G. Grant, C. B. Benson, G. L. Moneta et al., “Carotid artery stenosis: grayscale and Doppler ultrasound diagnosis—Society of Radiologists in Ultrasound consensus conference,” Ultrasound Quarterly, vol. 19, no. 4, pp. 190–198, 2003. View at: Publisher Site | Google Scholar
  7. H. J. M. Barnett, D. W. Taylor, M. Eliasziw et al., “Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis,” The New England Journal of Medicine, vol. 339, no. 20, pp. 1415–1425, 1998. View at: Publisher Site | Google Scholar
  8. E. Tatli, M. Buyuklu, and A. Altun, “An unusual but dramatic complication of coronary angiography: transient cortical blindness,” International Journal of Cardiology, vol. 121, no. 1, pp. e4–e6, 2007. View at: Publisher Site | Google Scholar
  9. R. Parry, J. R. Rees, and P. Wilde, “Transient cortical blindness after coronary angiography,” British Heart Journal, vol. 70, no. 6, pp. 563–564, 1993. View at: Publisher Site | Google Scholar
  10. J. M. Caille and M. Allard, “Neurotoxicity of hydrosoluble iodine contrast media,” Investigative Radiology, vol. 23, pp. S210–S212, 1988. View at: Google Scholar

Copyright © 2009 Nicola Morelli et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


More related articles

105 Views | 0 Downloads | 0 Citations
 PDF  Download Citation  Citation
 Download other formatsMore
 Order printed copiesOrder

Related articles

We are committed to sharing findings related to COVID-19 as quickly and safely as possible. Any author submitting a COVID-19 paper should notify us at help@hindawi.com to ensure their research is fast-tracked and made available on a preprint server as soon as possible. We will be providing unlimited waivers of publication charges for accepted articles related to COVID-19. Sign up here as a reviewer to help fast-track new submissions.