Teaching neuroimages altered mental status following carotid revascularization
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Teaching NeuroImages : Altered Mental Status Following Carotid Revascularization. Vivek Kalra , MD Balaji Rao , MD Ajay Malhotra , MD. Vignette. 69 year-old male presents with hypertensive crisis manifest by acute-onset confusion and elevated systolic pressures to the 160s

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Teaching NeuroImages : Altered Mental Status Following Carotid Revascularization

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Teaching neuroimages altered mental status following carotid revascularization

Teaching NeuroImages: Altered Mental Status Following Carotid Revascularization

VivekKalra, MD

BalajiRao, MD

Ajay Malhotra, MD


Vignette

Vignette

  • 69 year-old male presents with hypertensive crisis manifest by acute-onset confusion and elevated systolic pressures to the 160s

  • He underwent carotid endarterectomyone day earlier for 75% proximal internal carotid artery stenosis

  • Stenosis was discovered after he developed right facial droop from multiple embolic infarcts in the left middle cerebral artery distribution two weeks earlier

Kalra et al


Imaging

Imaging

B

C

D

A

rCBV

MTT

rCBF

Kalra et al


Perfusion imaging of cerebral hyperperfusion syndrome following revascularization

Perfusion Imaging of Cerebral Hyperperfusion Syndrome Following Revascularization

  • Cerebral Hyperperfusion Syndrome (CHS) following revascularization may present as ipsilateral headache, focal seizure, and/or neurological deficit

  • CHS is caused by loss of autoregulation, hypertension, and ischemia-reperfusion injury resulting in increased regional blood flow and vascular congestion

  • Non-perfusion imaging may show intraparenchymal hemorrhage or edema

  • Perfusion imaging shows increased relative blood flow, increased relative blood volume, and decreased mean transit time

  • Labetalol and clonidine are used for aggressive blood pressure control until cerebral autoregulation is restored

Kalra et al


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