Computed tomography perfusion abnormalities after carotid endarterectomy help in the diagnosis of reversible cerebral vasoconstriction syndrome

Masis Isikbay, MD; Kazim H. Narsinh, MD; Sergio Arroyo, MD, PhD; Wade S. Smith, MD, PhD; Daniel L. Cooke, MD; Randall T. Higashida, MD; Matthew R. Amans, MD

Journal of Vascular Surgery Cases and Innovative Techniques (Mar 2021)

Computed tomography perfusion abnormalities after carotid endarterectomy help in the diagnosis of reversible cerebral vasoconstriction syndrome

Masis Isikbay, MD,
Kazim H. Narsinh, MD,
Sergio Arroyo, MD, PhD,
Wade S. Smith, MD, PhD,
Daniel L. Cooke, MD,
Randall T. Higashida, MD,
Matthew R. Amans, MD

Affiliations

Masis Isikbay, MD: Department of Radiology and Biomedical Imaging, University of California, San Francisco, School of Medicine, San Francisco, Calif
Kazim H. Narsinh, MD: Department of Radiology and Biomedical Imaging, University of California, San Francisco, School of Medicine, San Francisco, Calif
Sergio Arroyo, MD, PhD: Department of Neurology, University of California, San Francisco, School of Medicine, San Francisco, Calif
Wade S. Smith, MD, PhD: Department of Neurology, University of California, San Francisco, School of Medicine, San Francisco, Calif
Daniel L. Cooke, MD: Department of Radiology and Biomedical Imaging, University of California, San Francisco, School of Medicine, San Francisco, Calif
Randall T. Higashida, MD: Department of Radiology and Biomedical Imaging, University of California, San Francisco, School of Medicine, San Francisco, Calif
Matthew R. Amans, MD: Department of Radiology and Biomedical Imaging, University of California, San Francisco, School of Medicine, San Francisco, Calif; Correspondence: Matthew R. Amans, MD, Department of Radiology and Biomedical Imaging, University of California, San Francisco, School of Medicine, 505 Parnassus Ave, Rm M391, Box 0628, San Francisco, CA 94143

Journal volume & issue: Vol. 7, no. 1
pp. 171 – 175

Abstract

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Acute neurologic deficits in the postoperative period after carotid endarterectomy (CEA) can prompt extensive diagnostic evaluation. Reversible cerebral vasoconstriction syndrome (RCVS) is an underrecognized cause of acute neurologic deficit after CEA. We present the case of RCVS in an 84-year-old male patient who had experienced left limb weakness after CEA, prompting multiple code stroke activations. The present case is novel because the obtained computed tomography perfusion imaging studies demonstrated abnormalities that have not been previously described in patients with RCVS. These findings, combined with the cerebral angiography findings, led to the rapid diagnosis and delivery of intra-arterial vasodilator therapy. He experienced subsequent resolution of his symptoms and radiologic abnormalities.

Published in Journal of Vascular Surgery Cases and Innovative Techniques

ISSN: 2468-4287 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Surgery; Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system
Website: https://www.sciencedirect.com/journal/journal-of-vascular-surgery-cases-innovations-and-techniques

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Abstract

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