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SUCCESSFUL MANAGEMENT OF CEREBRAL HYPERPERFUSION SYNDROME AFTER BRIDGING INTRAVENOUS-INTRARTERIAL THROMBOLYSIS FOR ACUTE MCA OCCLUSION

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ESOC-2019

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Abstract

Cerebral hyperperfusion syndrome (CHS) can complicate acute revascularization procedures, especially carotid endarterectomy, carotid angioplasty with stenting and stenting of intracranial vessels [Ho et al, 2000; Lieb et al, 2012]. CHS is caused by impaired cerebral autoregulation, hypertension and ischemia-reperfusion injury resulting in increased regional blood flow and vascular congestion [Adhiyaman et al, 2007; van Mook et al, 2005]. Clinical presentation may include hyperacute as well as delayed onset of headache, seizures and focal motor weakness. MRI features include oedema, hemorrhage or hyperperfusion [Pan et al, 2007; Farooq et al, 2016]. Risk factors include diabetes, older age, hypertensive microangiopathy, poor collaterals. Currently, no specific treatments are available. Methods: Case report Acute onset of aphasia and right hemiplegia in a 69 years-old male, suffering from diabetes and hypertension. CT scan was normal, angio-CT revealed left MCA occlusion. Bridging intravenous-intrarterial thrombolysis produced complete recanalization of left MCA. After the procedure, early neurological deterioration and recurrent partial motor seizures occurred. MRI scan revealed left hemispheric cortical swelling, consistent with EEG theta and delta waves. Severe hypertension, fever and hyperglycemia were noticed; the patient was administered antihypertensives, acetaminophen and insulin. Restoration of normal blood pressure, body temperature and improvement of glycemic control resulted in rapid clinical improvement. Follow-up MRI and EEG normalized. Conclusions: CHS after intracranial endovascular procedures has been rarely reported. Furthermore, an early clinical recovery with subsequent complete reversal of instrumental abnormalities has never been reported. We suggest the role of prompt management of hypertension, hyperthermia and hyperglycemia as a potential remedial strategy.

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© Copyright 2019 Morressier GmbH.
All rights reserved.