Three cases of hyperperfusion syndrome identified by daily Transcranial Doppler investigation after carotid surgery

Background: cerebral hyperperfusion syndrome (HS), occurs in 0.5-1% of patients undergoing carotid endarterectomy (CEA), and may result in intracerebral haemorrhage and death. Aim: to diagnose HS by means of postoperative Transcranial Doppler (TCD). Methods: between 1998 and 2001 nearly all 112 patients who underwent CEA were monitored for four days postoperatively by Transcranial Doppler. Results: there were 3 patients with HS. All three showed TCD abnormalities hours before developing symptoms. One patient developed a full blown HS. Presumably, symptoms in the other two patients could be prevented by timely starting or restoring anti-hypertensive treatment. Conclusion: daily TCD investigation in all patients undergoing CEA seems an effective strategy for the presymptomatic detection of HS.