Cerebral Flow Dysregulation Encephalopathy Following Carotid Stenting Procedure: Multiparametric CT and EEG Characteristics.

Abstract

Introduction: Cerebral hypoperfusion syndrome (CHS) involves a range of neurological symptoms originally recognized as a complication of carotid endarterectomy but also observed after carotid artery stenting. CHS is a rare cause of stroke mimic, posing a challenging differential diagnosis, especially in the hyperacute phase.

Case presentation: In this case report, we investigate the potential diagnostic and predictive roles in the acute phase through a novel approach using multiparametric CT [including non-enhanced CT (NECT), single-phase CT angiography (CTA), perfusion CT (CTP)] and electroencephalogram (EEG) in a 75-year-old male with acute hypoperfusion encephalopathy/cerebral flow dysregulation after carotid stenting. Follow-up imaging was performed with NECT, CTP, and EEG at 24 and 72 hours.

Conclusions: This clinical case supports the hypothesis that multiparametric CT, combined with EEG and clinical evaluation, may be useful in the differential diagnosis between CHS, ischemic events, status epilepticus, and stroke mimics in the emergency setting. Moreover, the repeated use of these tests offers a valuable and innovative approach to monitoring the clinical progression of this condition.