Kopfschmerzen und neurologische Ausfälle nach Karotisendarteriektomie – das zerebrale Hyperperfusionssyndrom (CHS)

Zusammenfassung

Eine 79-jährige Patientin stellte sich mit linksseitigen Kopfschmerzen, globaler Aphasie, Desorientiertheit und leichter Agitiertheit 7 Tage nach Durchführung einer Endarteriektomie der linken Arteria carotis interna bei symptomatischer 90–95 %iger Stenose vor. In der Magnetresonanztomografie des Schädels zeigte sich in den Perfusionsaufnahmen eine Hyperperfusion, ein zerebrales vasogenes Ödem und in der Computertomografie (CT) eine Subarachnoidalblutung links parietal. Aufgrund der Klinik und der kernspintomografischen Aufnahmen konnte die Diagnose eines Hyperperfusionssyndroms gestellt werden. Unter der antihypertensiven Behandlung und engmaschigem Blutdruckmonitoring kam es innerhalb der folgenden Tage zu einem Sistieren der Symptomatik.

Abstract

A 79-year-old female patient presented with global aphasia, ipsilateral headache, confusion and agitation 7 days after she underwent left carotid endarterectomy for treatment of a symptomatic 90–95 % stenosis of the left internal carotid artery. The MRI (magnetic resonance imaging) of the brain showed an ipsilateral hyperperfusion, cerebral vasogenic oedema of the white matter while CT (computed tomography) demonstrated a small subarachnoid haemorrhage. We diagnosed a hyperperfusion syndrome. Under antihypertensive treatment the blood pressure was strictly controlled and closely monitored and the symptoms resolved within the following days.

Schlüsselwörter

Karotisendarteriektomie - Hyperperfusion - Kopfschmerzen - Komplikationen - intrazerebrale Blutungen

Keywords

carotid endarterectomy - hyperperfusion - headache - complications - intracerebral haemorrhage

Literatur

• 1 Noorani A, Sadat U, Gaunt M E. Cerebral hemodynamic changes following carotid endarterectomy: „cerebral hyperperfusion syndrome”.  Expert Rev Neuroth. 2010;  10 217-223
• 2 Hosoda K, Kawaguchi T, Shibata Y et al. Cerebral vasoreactivity and internal carotid artery flow help to identify patients at risk for hyperperfusion after carotid endarterectomy.  Stroke. 2001;  32 1567-1573
• 3 Reigel M, Hollier L, Sundt T et al. Cerebral hyperperfusion syndrome: a cause of neurologic dysfunction after carotid endarterectomy.  J Vasc Surg. 1987;  5 628-634
• 4 Ho D, Wang Y, Chui M et al. Epileptic seizures attributed to cerebral hyperperfusion aufter percutaneous transluminal angioplasty and stenting of the internal carotid artery.  Cereb diseases. 2000;  10 374-379
• 5 Abou-Chebl A, Yadav J S, Reginelli J P et al. Intracranial hemorrhage and hyperperfusion syndrome following carotid arery stenting. Risk factors, prevention and treatment.  J Am Coll Cardiol. 2004;  43 1596-1601
• 6 Ille O, Woimant F, Pruna A et al. Hypertensive encephalopathy after bilateral carotid endarterectomy.  Stroke. 1995;  26 488-491
• 7 Nourae S R, Al Rawi P F, Sigaudo-Roussel D et al. Carotid endarterectomy impairs blood pressure homeostasis by reducing the physiologic baroreflex reserve.  J Vasc Surg. 2005;  41 631-637
• 8 Spetzler R F, Wilson C B, Weinstein P et al. Normal perfusion pressure breakthrough theory.  Clin Neurosurg. 1978;  25 651-672
• 9 Schroeder T, Sillesen H, Sorensen O et al. Cerebral hyperperfusion following carotid endarterectomy.  J Neurosurg. 1987;  66 824-829
• 10 Kitagawa K. Carotid stenosis, baroreceptor sensitivity and cerebral autoregulation – implication for cerebral hyperperfusion syndrome.  Circul journal. 2010;  74 2058-2059
• 11 Van Mook W N, Rennenberg R J, Schurink G W et al. Cerebral hyperperfusion syndrome caused by prolonged impairment of cerebrovascular autoregulation after carotid endarterectomy: a case report.  Neurosurgery. 2004;  54 1258-1262
• 12 Ogasawara K, Mikami C, Inoue T et al. Delayed cerebral hyperperfusion syndrome caused by prolonged impairment of cerebrovascular autoregulation after carotid endarterectomy: a case report.  Neurosurgery. 2004;  54 1258-1262
• 13 Breen J C, Caplan L R, DeWitt L D et al. Brain edema after carotid surgery.  Neurology. 1996;  46 175-181
• 14 McCabe D J, Brown M M, Clifton A. Fatal cerebral reperfusion hemorrhage after carotid stenting.  Stroke. 1999;  30 2483-2486
• 15 Hartmann M, Weber R, Zoubaa S et al. Fatal subarachnoid hemorrhage after carotid stenting.  J Neuroradiol. 2004;  31 63-66
• 16 Kaku Y, Yoshimura S, Kokuzawa J. Factors predictive of cerebral hyperperfusion after carotid angioplasty and stent placement.  AJNR. 2004;  25 1403-1408
• 17 Kawaguchi T, Shibata Y, Kamei M et al. Cerebral vasoreactivity and internal carotid artery flow help to identify patients at risk for hyperperfusion after carotid endarterectomy.  Stroke. 2001;  32 1567-1573
• 18 Kuroda S, Kamiyama H, Abe H et al. Acetazolamide test in detecting reduced cerebral perfusion reerve and predicting long-term prognosis in patients with internal carotid artery occlusion.  Neurosurg. 1993;  32 912-919
• 19 Oyukawa H, Kobayashi M, Mikami C et al. Prediction and monitoring of cerebral hyperperfusion after carotid endarterectomy by using single-photon emission computerized tomography scanning.  N Neurosurg. 2003;  99 504-510
• 20 Ogasawara K, Inoue T, Kobayashi M et al. Cerebral hyperperfusion following carotid endarterectomy: diagnostic utility of intraoperative transcranial doppler ultrasonography compared with singlephoton emission computed tomography study.  Am J Neuroradiol. 2005;  26 252-257
• 21 Fujimoto S, Toyoda K, Inoue T et al. Diagnostic impact of transcranial color-coded real-time sonography with echo contrast agents for hyperperfusion syndrome after carotid endarterectomy.  Stroke. 2004;  35 1852-1856