ADD-ONS

Cerebral hyperperfusion syndrome (CHS)

Created 04/11/2021, last revision 07/05/2023

Cerebral Hyperperfusion (reperfusion) Syndrome (CHS) can occur within hours to days after a revascularization procedure (carotid endarterectomy, carotid artery stenting, revascularization in moyamoya syndrome, severe aortic stenosis repair)
- the peak incidence of CHS and hemorrhage after CEA is 5-7 days and 12-48 h after CAS [Ogasawara, 2007]
- longer delay (days to weeks) was reported as well
- CHS following aortic stenosis surgery may lead to bilateral lesions
incidence 1-14% (usually approximately 7%) according to various authors
- CEA and CAS pose similar risks (Galyfos, 2017)
- incidence is higher in moyamoya surgery (Hayashi, 2012)
most patients with CHS have mild symptoms and signs
the cornerstone of prevention is strict perioperative BP correction (at least for 14-21 days)

Pathophysiology

Content available only for logged-in subscribers (registration will be available soon)

severe headache
- worsening in the prone position
- ipsilateral to the lesion side or diffuse
impaired consciousness
epileptic seizures (often focal)
focal neurologic deficit (usually in ICH)

Content available only for logged-in subscribers (registration will be available soon)

rigorous blood pressure correction (ideally <120/85 mmHg) – it also serves as a prevention
in case of seizure activity, administer AE drugs (PHE, VPA, LEV) → acute symptomatic seizures
antiedema therapy

discontinue antiplatelet therapy, consider platelet concentrate infusion
administer SOLUMEDROL 25 mg IV. (to neutralize the effect of clopidogrel or other thienopyridines) [Qureshi, 2008]
if the CT scan indicates no progression in 24h, patients with stent should be given aspirin; postpone clopidogrel therapy for 5-7 days