Computed tomographic perfusion imaging of non-hemorrhagic cerebral hyperperfusion syndrome and reversal following medical treatment after carotid artery angioplasty and stenting.

OBJECTIVE AND IMPORTANCE

Cerebral hyperperfusion syndrome (CHS) is an infrequent syndrome observed in carotid endarterectomy and carotid angioplasty and stenting (CAS). The case history is presented of a patient with CT perfusion imaging of non-hemorrhagic CHS and reversal following medical treatment after CAS.

CLINICAL PRESENTATION

A right-handed Caucasian man in his late 70s presented with sudden onset right upper extremity plegia and anesthesia and right facial parasthesias with complete resolution within 24 h. CT angiography (CTA) revealed 75% left cervical carotid artery stenosis. The patient underwent uneventful left CAS. Six hours after the procedure he developed verbal perseveration and right upper extremity paresis. CT perfusion imaging showed increased mean transient time in the left parieto-occipital lobe without changes in cerebral blood flow or cerebral blood volume. A clinical diagnosis of CHS was suspected. Several hours after lowering the blood pressure his symptoms improved. A follow-up CTA with CT perfusion was performed which showed complete resolution of the previously observed changes in mean transient time. The patient was discharged home without neurological sequelae.

CONCLUSION

This is the first report to our knowledge of CT perfusion imaging for CHS with post-symptomatic imaging following clinical resolution. Prompt CHS evaluation may include CT perfusion imaging to assist diagnostic accuracy. Rigorous blood pressure control remains the mainstay of treatment.