1 / 4

Teaching NeuroImages : Altered Mental Status Following Carotid Revascularization

Teaching NeuroImages : Altered Mental Status Following Carotid Revascularization. Vivek Kalra , MD Balaji Rao , MD Ajay Malhotra , MD. Vignette. 69 year-old male presents with hypertensive crisis manifest by acute-onset confusion and elevated systolic pressures to the 160s

waite
Download Presentation

Teaching NeuroImages : Altered Mental Status Following Carotid Revascularization

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Teaching NeuroImages: Altered Mental Status Following Carotid Revascularization VivekKalra, MD BalajiRao, MD Ajay Malhotra, MD

  2. Vignette • 69 year-old male presents with hypertensive crisis manifest by acute-onset confusion and elevated systolic pressures to the 160s • He underwent carotid endarterectomyone day earlier for 75% proximal internal carotid artery stenosis • Stenosis was discovered after he developed right facial droop from multiple embolic infarcts in the left middle cerebral artery distribution two weeks earlier Kalra et al

  3. Imaging B C D A rCBV MTT rCBF Kalra et al

  4. Perfusion Imaging of Cerebral Hyperperfusion Syndrome Following Revascularization • Cerebral Hyperperfusion Syndrome (CHS) following revascularization may present as ipsilateral headache, focal seizure, and/or neurological deficit • CHS is caused by loss of autoregulation, hypertension, and ischemia-reperfusion injury resulting in increased regional blood flow and vascular congestion • Non-perfusion imaging may show intraparenchymal hemorrhage or edema • Perfusion imaging shows increased relative blood flow, increased relative blood volume, and decreased mean transit time • Labetalol and clonidine are used for aggressive blood pressure control until cerebral autoregulation is restored Kalra et al

More Related