Postcarotid endarterectomy symptoms - Pre- and postoperative clinical and MRI findings

Background. The hyperperfusion syndrome represents a highly debated clinica l entity, without having yet any clinically identifiable limits. The correl ation of clinical with pre- and postoperative magnetic resonance imaging (M RI) findings following carotid endarterectomy in patients with a possible h yperperfusion syndrome was investigated. Methods. Design: Prospective clinical and laboratory study. Setting: At the Aretaieio University Hospital. Measures: Comparison to the postoperative c linical symptomatic and MRI findings. Patients. We studied 30 patients (mea n age 66.6) of whom 14 (46.6%) were asymptomatic, 16 (53.4%) were symptomat ic, 17 (56.6%) were hypertensive, 18 (60%) hyperlipidaemic, 5 (16.6%) diabe tic and 17 (56.6%) had coronary artery disease. Results. Twenty-one patients (70%) exhibited disturbances such as ipsilater al headache, seizures, vomiting or facial pain; immediate postoperative MRT scans revealed new ischaemic foci in 4 (19%) without any objective neurolo gical findings. Lesions displayed in postoperative MRI scans did not always cause symptoms and normal findings on MRI did not exclude the presence of symptoms. Hypertension favoured the presence of subjective disturbances, wi thout necessarily any change in the MRI appearances. Preoperative MRI and c linical findings did not contribute to the identification of patients who m ight have exhibited postoperative symptoms. Thus, the symptomatology remain s unclear and open to debate, as a variety of other conditions may produce the same clinical picture postoperatively. Conclusions. Subjective disturbances, objective neurological findings and M RI abnormalities with or without hypertension may appear independently afte r carotid endarterectomy, a fact which makes the pathogenesis of the hyperp erfusion syndrome more difficult to elucidate.