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Cerebral Hyperperfusion Syndrome Presenting As Status Epilepticus Following Carotid Endarterectomy

Cerebral Hyperperfusion Syndrome (CHS) is a rare syndrome, commonly described as a prodrome of symptoms including a severe ipsilateral headache, focal neurological deficits, intracerebral hemorrhage, and occasionally includes seizures or encephalopathy. Our case involves a 76-year-old man who underw...

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Autores principales: Edwards, Alicia M, Birchler, Caleb R, Park, Sean, Baker, Jennifer M, Molnar, Robert G
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8776524/
https://www.ncbi.nlm.nih.gov/pubmed/35103131
http://dx.doi.org/10.7759/cureus.20551
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author Edwards, Alicia M
Birchler, Caleb R
Park, Sean
Baker, Jennifer M
Molnar, Robert G
author_facet Edwards, Alicia M
Birchler, Caleb R
Park, Sean
Baker, Jennifer M
Molnar, Robert G
author_sort Edwards, Alicia M
collection PubMed
description Cerebral Hyperperfusion Syndrome (CHS) is a rare syndrome, commonly described as a prodrome of symptoms including a severe ipsilateral headache, focal neurological deficits, intracerebral hemorrhage, and occasionally includes seizures or encephalopathy. Our case involves a 76-year-old man who underwent a left carotid endarterectomy (CEA) for symptomatic high-grade stenosis of his left carotid artery. Post-operative day one, the patient was seen and examined in the early morning and found to be doing well, with blood pressures well-controlled and at his neurologic baseline. Three hours later, he was reported to have a sudden spike in his blood pressure and was experiencing focal motor seizures involving the right arm and face, both of which were unrelieved by anti-hypertensives and anti-seizure medications. The patient subsequently developed worsening respiratory function requiring intubation for status epilepticus. Repeat head and neck imaging with CT, CT angiography, and MRI demonstrated the known previous subacute infarct with new cerebral edema, patent carotid arteries bilaterally, and no acute infarct or intracerebral hemorrhage. While CHS is a rare syndrome with well-documented symptomatology, we present a unique case in which focal motor status epilepticus was the only presenting symptom in a patient who otherwise meets the criteria of CHS based on radiographic evidence of cerebral edema following an elective CEA.
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spelling pubmed-87765242022-01-30 Cerebral Hyperperfusion Syndrome Presenting As Status Epilepticus Following Carotid Endarterectomy Edwards, Alicia M Birchler, Caleb R Park, Sean Baker, Jennifer M Molnar, Robert G Cureus Cardiac/Thoracic/Vascular Surgery Cerebral Hyperperfusion Syndrome (CHS) is a rare syndrome, commonly described as a prodrome of symptoms including a severe ipsilateral headache, focal neurological deficits, intracerebral hemorrhage, and occasionally includes seizures or encephalopathy. Our case involves a 76-year-old man who underwent a left carotid endarterectomy (CEA) for symptomatic high-grade stenosis of his left carotid artery. Post-operative day one, the patient was seen and examined in the early morning and found to be doing well, with blood pressures well-controlled and at his neurologic baseline. Three hours later, he was reported to have a sudden spike in his blood pressure and was experiencing focal motor seizures involving the right arm and face, both of which were unrelieved by anti-hypertensives and anti-seizure medications. The patient subsequently developed worsening respiratory function requiring intubation for status epilepticus. Repeat head and neck imaging with CT, CT angiography, and MRI demonstrated the known previous subacute infarct with new cerebral edema, patent carotid arteries bilaterally, and no acute infarct or intracerebral hemorrhage. While CHS is a rare syndrome with well-documented symptomatology, we present a unique case in which focal motor status epilepticus was the only presenting symptom in a patient who otherwise meets the criteria of CHS based on radiographic evidence of cerebral edema following an elective CEA. Cureus 2021-12-20 /pmc/articles/PMC8776524/ /pubmed/35103131 http://dx.doi.org/10.7759/cureus.20551 Text en Copyright © 2021, Edwards et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Cardiac/Thoracic/Vascular Surgery
Edwards, Alicia M
Birchler, Caleb R
Park, Sean
Baker, Jennifer M
Molnar, Robert G
Cerebral Hyperperfusion Syndrome Presenting As Status Epilepticus Following Carotid Endarterectomy
title Cerebral Hyperperfusion Syndrome Presenting As Status Epilepticus Following Carotid Endarterectomy
title_full Cerebral Hyperperfusion Syndrome Presenting As Status Epilepticus Following Carotid Endarterectomy
title_fullStr Cerebral Hyperperfusion Syndrome Presenting As Status Epilepticus Following Carotid Endarterectomy
title_full_unstemmed Cerebral Hyperperfusion Syndrome Presenting As Status Epilepticus Following Carotid Endarterectomy
title_short Cerebral Hyperperfusion Syndrome Presenting As Status Epilepticus Following Carotid Endarterectomy
title_sort cerebral hyperperfusion syndrome presenting as status epilepticus following carotid endarterectomy
topic Cardiac/Thoracic/Vascular Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8776524/
https://www.ncbi.nlm.nih.gov/pubmed/35103131
http://dx.doi.org/10.7759/cureus.20551
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