Teaching NeuroImages: Combined retinal and cerebral hyperperfusion syndrome after carotid thromboendarterectomy

A 62-year-old man presented with mild left hemiparesis, headache, and blurred vision of his right eye. Ten days before, he had undergone thromboendarterectomy because of subtotal stenosis of his right internal carotid artery. MRI revealed confluent white-matter edema together with focal hemorrhage consistent with cerebral hyperperfusion syndrome (CHS; figure 1). Likewise, funduscopy showed small retinal hemorrhages confined to the right eye (figure 2). Under careful blood pressure control, symptoms and brain edema fully resolved within weeks. CHS occurs in around 3% of patients undergoing carotid thromboendarterectomy and can induce severe neurologic deficits.1 Rarely, hyperperfusion also involves the ipsilateral eye.2

Source: Neurology - November 25, 2013 Category: Neurology Authors: Ketteler, S., Djalali-Talab, Y., Dafotakis, M., Wiesmann, M., Schulz, J. B., Haarmeier, T. Tags: Stroke prevention, Retina, Visual loss, All Cerebrovascular disease/Stroke RESIDENT AND FELLOW SECTION Source Type: research