In carotid surgery immediate neurological deficits are due to thrombosis, embolization or carotid clamping ischemia; in few cases the postoperative neurological deficit, often transient, seems to be related to a cerebral hyperperfusion syndrome that can be characterized, in the early postoperative period, by migraine on the operated side and, in the most severe cases, by seizures, hemyparesis and hemyplegia. We have divided the last 108 consecutive patients operated on into two groups, according to the angiographic findings; the first one (A) of 59 patients with 19 isolated severe carotid stenosis, 29 bilateral stenosis, 9 occlusion and severe controlateral carotid stenosis, 22 bilateral common carotid occlusion; the second group (B) (49 patients) with a monolateral stenosis. All the patients were preoperatively studied with Duplex-scan, angiography and cerebral CT-scan. During the operation, the measurement of the stump pressure and a continuous monitoring of cerebral function by SEP were performed. In the first group (A) we have reported 25 (42,3%) cases of migraine and 2 (3.4%) cases of severe hyperperfusion syndrome: one with a transient neurological deficit and seizures, the other with a permanent deficit due to an intracerebral hemorrage. In the second group (B) we have reported only 9 (18.2%) cases of migraine without neurological deficit. We haven't found any significant difference among the two groups regarding age, risk factors, associated vascular pathology and clinical features. This syndrome seems to be related, after the cerebral revascularization, to a pre-resistent chronic cerebral ischemia with loss of cerebral autoregolatory mechanisms.
|Translated title of the contribution||Cerebral hyperperfusion syndrome after carotid endarterectomy|
|Number of pages||4|
|Issue number||4 SUPPL.|
|Publication status||Published - 1991|
ASJC Scopus subject areas