Hypertensive encephalopathy after bilateral carotid endarterectomy.

Abstract:

BACKGROUND:Hypertension occurs frequently after carotid endarterectomy and may lead to cerebral vascular complications and myocardial infarction. Its pathophysiology has recently been related to surgically induced damage of carotid baroreceptors. CASE DESCRIPTION:A 45-year-old normotensive man with no history of epilepsy was admitted 3 weeks after bilateral carotid endarterectomy for severe repetitive paroxysmal headaches, vomiting, and agitation that were closely associated with attacks of marked hypertension. During one of these attacks, he had a grand mal seizure. Plasma catecholamine levels during hypertensive attacks were highly elevated despite the absence of pheochromocytoma, reflecting abnormalities in baroreceptor sensitivity that lead to unrestrained activation of the central sympathetic nervous system. Heart rate response to Valsalva maneuver showed suppression of the usual tachycardia, indicating baroreceptor reflex insensitivity. CONCLUSIONS:We report the first case of hypertensive encephalopathy associated with baroreflex failure syndrome after bilateral carotid endarterectomy. The role of blood pressure monitoring may be critical in revealing carotid baroreceptor insensitivity in such clinical settings.

journal_name

Stroke

journal_title

Stroke

authors

Ille O,Woimant F,Pruna A,Corabianu O,Idatte JM,Haguenau M

doi

10.1161/01.str.26.3.488

subject

Has Abstract

pub_date

1995-03-01 00:00:00

pages

488-91

issue

3

eissn

0039-2499

issn

1524-4628

journal_volume

26

pub_type

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