Retinal hemorrhage as a unique ophthalmic manifestation of cerebral hyper perfusion syndrome

Eitan Heldenberg,Arie Bass

doi:10.4236/wjcd.2013.34053

Abstract

Cerebral hyperperfusion syndrome (CHPS) is a rare, complication of carotid artery revascularization. Acute retinal hemorrhage is a very rare entity previously described as a manifestation of CHPS following carotid artery stenting (CAS), but to the best of our knowledge, not yet described as a complication of carotid surgery. An Ascending Aorta to bilateral Carotid bypass was performed in a 35-year-old woman with active Takayasu arteritis and 95% symptomatic stenosis of both common carotid arteries. Severe retinal hemorrhage appeared on the second post operative day combined with high blood pressure, brain edema on CT scan and grand mal seizures. It seems that fundoscopic examination following carotid revascularization of tight can be helpful in identifying those patients who develop symptoms suggesting of CHPS.

Highlights

Cerebral hyperperfusion syndrome (CHPS) first described by Sundt in 1981 is a potentially lethal complication, directly related to carotid revascularization [1]
Acute retinal hemorrhage is a very rare entity previously described as a manifestation of CHPS following carotid artery stenting (CAS), but to the best of our knowledge, not yet described as a complication of carotid surgery
An Ascending Aorta to bilateral Carotid bypass was performed in a 35-year-old woman with active Takayasu arteritis and 95% symptomatic stenosis of both common carotid arteries

Summary

INTRODUCTION

Cerebral hyperperfusion syndrome (CHPS) first described by Sundt in 1981 is a potentially lethal complication, directly related to carotid revascularization [1]. CHPS presents with a wide spectrum of manifestations ranging from mild headaches to lethal intracerebral hemorrhage (ICH) [1,2]. The incidence of CHPS, as reviewed in various clinical series, has been 0.3% - 2.7% [2]. We describe retinal hemorrhage as a manifestation of CHPS in a young patient with Takaysu’s arteritis who underwent Ascending Aorta to bilateral distal Common Carotid Arteries bypass and developed brain edema as a manifestation of CHPS

CASE PRESENTATION

DISCUSSION