Cerebral vasoconstriction after carotid surgery.

Abstract

Constriction of intracranial arteries occurs during some migraine attacks, after subarachnoid bleeding and meningitis, and also during eclampsia, severe hypertension, and in users of sympatheticomimetic drugs. Call et al.1 described a syndrome of spontaneous reversible cerebral vasoconstriction mostly occurring in young women characterized by headache, nausea, focal neurologic signs, and seizures. We now report two patients who developed a symptomatic cerebral vasoconstriction syndrome 5 to 7 days after uneventful carotid endarterectomy. Vasoconstriction should be considered in the differential diagnosis of headache and neurologic signs after carotid artery surgery. Case reports. Patient 1. A 50-year-old man was evaluated for carotid artery disease because of attacks of right transient monocular visual loss and a right carotid bruit. He was a heavy cigarette smoker and used alcohol liberally, but not illicit drugs. He had leg claudication. For 3 months he had headache and visual symptoms considered migrainous in addition to the right monocular visual loss attacks. He had no history of hypertension. Angiography showed severe right carotid artery stenosis (95% luminal narrowing) in the neck and normal intracranial circulations. A right carotid endarterectomy was performed without complications and he was discharged home. One week later, he reported more prominent right-sided headaches, loss of vision to his left, and transient numbness of his left limbs. Blood pressure …