Cerebral hyperperfusion syndrome after spontaneous recanalisation of carotid in-stent thrombosis.

Aguilar-Salinas P, et al. BMJ Case Rep 2017. doi:10.1136/bcr-2017-220710 Description A 68-year-old man with medical history significant for hypertension and stroke was transferred to our hospital with new onset dysarthria, right face and arm weakness following left carotid stent deployed 24 hours before. The National Institutes of Health Stroke Scale at admission was 7. Head and neck CT angiographies (CTAs) were performed demonstrating in-stent thrombosis of the left carotid artery (figure 1A) and a CT perfusion showed no core infarct but a perfusion defect within the left middle cerebral artery (MCA) territory, as defined by a Tmax greater than 6 s, measuring 78.9 mL (figure 1B). Decision was made to treat him conservatively by starting heparin gtt and blood pressure augmentation with norepinephrine for systolic blood pressure goal >160 mm Hg. Forty-eight hours after admission, the patient complained of severe headache associated with right-sided paraesthesias and right-sided motor focal seizure without impaired