[Reperfusion syndrome with cerebral vasogenic edema after carotid artery endarterectomy].

BACKGROUND

Reperfusion (or hyperperfusion) syndrome may be a possible complication of carotid artery endarterectomy or angioplasty.

METHODS

We report the case of a 54-year-old man who underwent a right carotid endarterectomy for an asymptomatic carotid stenosis and developed reperfusion syndrome a few days after surgery. The symptoms were marked by a prolonged partial epileptic status and then left hemiplegia lasting several days. Brain MRI with Diffusion sequences was normal, whereas there was a right frontoparietal hypersignal in FLAIR sequences, suggesting the presence of brain vasogenic oedema. Clinical and neuroradiological outcomes were good, confirming the relative good prognosis attributed to vasogenic brain oedema in previous similar publications. This condition may be misdiagnosed as cytotoxic brain oedema, another possible complication of carotid endarterectomy, whose management and prognosis are different.

CONCLUSIONS

When a focal neurological deficit or epileptic seizures follow carotid artery endarterectomy, it is important to consider reperfusion syndrome. MRI (with FLAIR and Diffusion sequences) will show a vasogenic brain oedema, with a better prognosis than what can be expected with cytotoxic oedema.