cerebral hyperperfusion
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7/17/2019 Cerebral Hyperperfusion
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Carotid Artery Stenosis
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CAS
Risk factors:
− Family Hx of atherosclerosis, Age > 75, High LL, Smoking, H!", #, $%esity,Sedentary lifestyle
Signs and Sx &arning signs of stroke
− Ama'rosis f'gax
− (eakness)n'm%ness of one side of the face)arms)legs
− Sl'rred s*eech, diffic'lty talking
− Loss of coordination
+hysical exam carotid %r'its
iagnostic -maging
− Carotid d'*lex .S, carotid angiogra*hy, #RA, C! scan, or C!A
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CEA
-ndications for *roced're
+ro/en -ndications
− $ne or more !-As in the last 0 months and carotid stenosis 1723
− #ild stroke &ith carotid stenosis 1723
Acce*ta%le 4't "ot +ro/en -ndications
− !-As in the *ast 0 months and stenosis of 523 to 03
− +rogressi/e stroke and stenosis 1723
− #ild or moderate stroke in the *ast 0 months and stenosis of 523 to 03
− Carotid endarterectomy i*silateral to !-As and stenosis 1723, com%ined&ith re6'ired coronary %y*ass grafting
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#RC Asym*tomatic Carotid S'rgery !rial
ACS!8
5 year risk of stroke 38
-mmediateC9A
n;502
eferredC9A
n;502
*
All *atients <= ;;=2 ?2=22;#en @=< ;2=5 ?2=222;
(omen <=2 7= 2=2@
Age ? 05 ;= =0< ?2=222;
Age 05B7 @=; =07 ?2=222;
02 B 23 S @=20 = ?2=222;
2 B 23 S <=@2 =50 ?2=222;
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C9A
For sym*tomatic carotid artery stenosis of 72 to 3&ith no se/ere coBmor%idities:
− C9A ""! 0=<
For sym*tomatic stenosis of 52 to 03:− C9A ""! @@
ASA sho'ld %e started %efore s'rgery and contin'ed*osto*erati/ely
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Com*lications of C9A
#-
Stroke
4leeding
Cer/ical hematoma
"er/e in'ry
-nfection
Carotid restenosis Cerebral hyperperfusion
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Case
56y F.
− Sept 25th: amaurosis fugax
− Carotid stenosis of 90% hx of !"#
− $ooed for CEA in August &'C(ed home
− )eturned *ith hemip+egia and spee,h diffi,u+ties
− CEA done urgent+y
− &e-e+oped pounding heada,he seiures andS$/200
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Cere%ral Hy*er*erf'sion Syndrome
Fail're of cere%ral a'toreg'lation *ost re/asc'larisation @=73of C9ADs8
− Com*ensation of CAS leads to chronic maximal dilation
− ilated /essels 'na%le to constrict after C9A
− Leads to edema and hemorrhage
− H!" is *rec'rsor to syndrome
Risk Factors:
− Stenosis >23 Stroke from CAS +resenting sym*toms
− H)A im*ro/ed &ith '*right *ost're se/ere, i*silateral, *o'nding8− "e'rological deficit hemi*legia, neglect, hemiano*ia, a*hasia8− SeiE're generaliEed or focal8− -CH 2=<B2=738− H)A normal after C9A 0@38 %'t mildBmoderate
x− S*asm, issection, stroke, hemorrhage−
SAH from *reBexisting ane'rysm
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S+9C! Scan
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#x
+rognosis de*ends on 4+ control
S4+ ?;52mmHg %e aggressi/e8
− - La%etalol, nitro*r'sside, nitroglycerine
Head C! R)$ stroke and hemorrhage
+henytoin for seiE're
)C ASA and antithrom%otics