Delayed Cerebral Hyperperfusion with Subarachnoid Haemorrhage after Carotid Artery Stenting
DML Tse, G Ho, CP Tsang, KH Chan, R Lee
Hong Kong J Radiol 2018;21:266-70
DOI: 10.12809/hkjr1816834
Cerebral hyperperfusion syndrome is a rare but serious complication after carotid revascularisation procedures that manifests as ipsilateral migraine-like headache, seizure, and transient focal neurological deficits in the absence of cerebral ischaemia. Cerebral hyperperfusion syndrome may lead to cerebral oedema and haemorrhage, and imaging findings of hyperperfusion may be seen. Cerebral hyperperfusion syndrome and haemorrhage after carotid artery stenting occurs most often in the first postoperative day and rarely after the first week. We report a case of a patient with delayed subarachnoid haemorrhage 16 days after carotid artery stenting, presenting with headache and focal neurological deficit, with associated imaging findings of hyperperfusion. Given the short hospital stays associated with carotid artery stenting, the present case highlights the need for vigilance by patients, carers, and clinicians for this serious complication.
Author affiliation(s):
DML Tse, G Ho, R Lee: Department of Radiology, Queen Mary Hospital, Pokfulam, Hong Kong
CP Tsang: Department of Neurosurgery, Queen Mary Hospital, Pokfulam, Hong Kong
KH Chan: Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
中文摘要
頸動脈支架術後蛛網膜下腔出血和遲發性腦高灌注綜合徵
謝民立、何潔明、曾振邦、陳灌豪、李雷釗
腦高灌注綜合徵是頸動脈血運重建術後罕見但嚴重的併發症，症狀表現為在沒有腦缺血的情況下出現同側偏頭痛類頭痛、癲癇發作和短暫局灶性神經功能缺損。腦高灌注綜合徵可導致腦水腫和出血，並可能有高灌注影像學表現。頸動脈支架術後腦高灌注綜合徵和出血大多在術後第一天發生，術後一周發生的機會很少。本文報告一名患者在頸動脈支架術後16天出現遲發性蛛網膜下腔出血、頭痛和局灶性神經功能缺損，並伴有高灌注影像學表現。鑑於與頸動脈支架術相關的住院時間短，本病例強調患者、護理人員和醫生須對這種嚴重併發症提高警覺。