post Carotid Endarterectomy Cerebral Hyperperfusion Syndrome
A 75-year male with reported past medical history of coronary artery disease, myocardial infarction, hypertension, right carotid artery stenosis. He had undergone right CEA 7 days ago. He was on aspirin and Plavix. He presented with hypertension and intractable grand mal seizures. Computed tomography (CT) scan performed at an outside hospital revealed subarachnoid hemorrhage in right temporal lobe (Figure. 1). He was subsequently sedated and intubated to protect his airways due to intractable seizures. CT angiography revealed persistent fetal origin of right PCA and increased vascularity of entire right cerebral hemisphere (Figure. 2). The bleeding vessel was not identified. Subsequently, the Magnetic Resonance Imaging (MRI) of the brain with IV contrast again revealed increased vascularity of right cerebral hemisphere (Figure. 3). Also, noted was diffuse cerebral edema involving right subcortical white matter (Figure. 4). An acute stroke involving posterior right thalamus was also identified (Figure. 5).