Fulminant Reversible Cerebral Vasoconstriction Syndrome After Carotid Endarterectomy for Asymptomatic Stenosis.

Abstract

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare complication after carotid endarterectomy (CEA). Only a limited number of prior cases of RCVS have been reported after CEA for asymptomatic carotid stenosis. In this report we present an unusual case of RCVS associated with multifocal intraparenchymal hemorrhage, subarachnoid hemorrhage, subdural hematoma, and ischemic stroke after CEA for asymptomatic carotid stenosis. We review preexisting studies and draw correlations with implications for understanding the mechanisms of RCVS. A high index of suspicion should be maintained in post-CEA patients presenting with headaches or focal neurologic deficits, and vigilance with serial vascular imaging may help minimize long-term complications.