Cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy associated with subarachnoid hemorrhage (SAH) and late cerebral ischemia: a case report

Introduction:
CHS is characterized by headache, hypertension, seizures and neurological deficits after carotid endarterectomy. We will report a case of CHS that patient presented SAH and late cerebral ischemia in context of vasospasm.
 
Clinical case:
63-year-old female, presented to the emergency department due to paroxysmal episodes of aphasia. Investigation showed stenosis of 95% of left internal carotid artery (Figure 1) and endarterectomy was performed with improvement of aphasia episodes. After 3 days, she presented headache, seizure and hypertension without CT scan acute changes. After diagnosis and management of CHS, the patient had a new episode of intense headache and hypertensive peak. New CT-scan revealed SAH (Figure 1). After 2 days, she had new episodes of aphasia without CT-scan acute changes. Transcranial doppler showed mild vasospasm (Figure 2).

Final considerations:
In this case, patient presented concomitant relatively rare complications: CHS after carotid endarterectomy, SAH and vasospasm with late cerebral ischemia. Although rare and life-threatening diseases, the patient recovered almost all symptoms and was discharged a few weeks later.

Cerebral hyperperfusion syndrome (CHS) after carotid endarterectomy associated with subarachnoid hemorrhage (SAH) and late cerebral ischemia: a case report