Kopfschmerzen und neurologische Ausfälle nach Karotisendarteriektomie – das zerebrale Hyperperfusionssyndrom (CHS)

 

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Zusammenfassung

Eine 79-jährige Patientin stellte sich mit linksseitigen Kopfschmerzen, globaler Aphasie, Desorientiertheit und leichter Agitiertheit 7 Tage nach Durchführung einer Endarteriektomie der linken Arteria carotis interna bei symptomatischer 90–95 %iger Stenose vor. In der Magnetresonanztomografie des Schädels zeigte sich in den Perfusionsaufnahmen eine Hyperperfusion, ein zerebrales vasogenes Ödem und in der Computertomografie (CT) eine Subarachnoidalblutung links parietal. Aufgrund der Klinik und der kernspintomografischen Aufnahmen konnte die Diagnose eines Hyperperfusionssyndroms gestellt werden. Unter der antihypertensiven Behandlung und engmaschigem Blutdruckmonitoring kam es innerhalb der folgenden Tage zu einem Sistieren der Symptomatik.

Abstract

A 79-year-old female patient presented with global aphasia, ipsilateral headache, confusion and agitation 7 days after she underwent left carotid endarterectomy for treatment of a symptomatic 90–95 % stenosis of the left internal carotid artery. The MRI (magnetic resonance imaging) of the brain showed an ipsilateral hyperperfusion, cerebral vasogenic oedema of the white matter while CT (computed tomography) demonstrated a small subarachnoid haemorrhage. We diagnosed a hyperperfusion syndrome. Under antihypertensive treatment the blood pressure was strictly controlled and closely monitored and the symptoms resolved within the following days.

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Dr. David Czell

Muskelzentrum / ALS clinic, Kantonsspital St. Gallen

Greithstr. 20

9007 St. Gallen, Switzerland

Email: david.czell@gmx.ch