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A difficult case
Cerebral vasoconstriction after carotid endarterectomy
  1. Diogo Fitas1,2,
  2. Marta Carvalho2,3,
  3. Pedro Castro2,3,
  4. Pedro Abreu2,3,
  5. Goreti Moreira4,
  6. Rosa Santos2,
  7. Elsa Azevedo2,3
  1. 1Department of Neurology, Santa Luzia Hospital, Viana do Castelo, Portugal
  2. 2Department of Neurology, São João Hospital Centre, Porto, Portugal
  3. 3Faculty of Medicine of University of Porto, Porto, Portugal
  4. 4Stroke Unit of São João Hospital Centre, Porto, Portugal
  1. Correspondence to Dr Diogo Fitas, Department of Neurology, Centro Hospitalar São João, Porto 4200 – 319, Portugal; cd_fitas{at}hotmail.com

Abstract

Carotid endarterectomy carries the risk of several complications. We report a 55-year-old woman with recurrent cerebral vasoconstriction postoperatively. She had bilateral high-grade internal carotid artery stenosis and underwent right endarterectomy because of transient left-sided sensory symptoms. She developed a reperfusion syndrome with severe right-sided headache, right frontotemporal oedema and increased velocities in transcranial Doppler ultrasound. Given her gradual increase of velocities and Lindegaard index, together with fixed left sensory and motor deficits, we performed CT angiography, which suggested cerebral vasoconstriction syndrome. A subsequent left carotid endarterectomy triggered a similar cerebrovascular response. We highlight the need for continuous monitoring of cerebral haemodynamics following carotid endarterectomy.

  • stroke
  • cerebrovascular disease
  • vascular surgery
  • ultrasound
  • MRI

https://doi.org/10.1136/practneurol-2017-001871

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    Footnotes

    • Contributors DF: conception and design, data collection, literature search, drafting the article and critical revision of the article. MC: conception and design, critical revision of the article, supervision and final approval of the version to be published. PC: data collection, critical revision of the article and final approval of the version to be published. PA: drafting the article and final approval of the version to be published. GM: critical revision of the article and final approval of the version to be published. RS: data collection, critical revision of the article and final approval of the version to be published. EA: conception and design, drafting the article, critical revision of the article, supervision and final approval of the version to be published.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned. Externally peer reviewed by William Whiteley, Edinburgh, UK.

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