Abstract
Objective: We report a case of nonconvulsive status epilepticus (NCSE) associated with cerebral hyperperfusion syndrome (CHS) after thrombectomy for left middle cerebral artery occlusion.
Case Presentation: A 68-year-old female was rushed to our hospital with impaired consciousness. A broad infarction of the left middle cerebral artery (MCA) area was detected by initial diffusion-weighted imaging (DWI). Therefore, we diagnosed her as having left MCA occlusion and performed urgent thrombectomy. Complete recanalization was achieved at 156 min from the onset. However, her consciousness remained impaired. We found that the initial DWI findings had disappeared, and the recanalization was maintained. On the third hospitalization day, MRI was carried out again, revealing hyperintense areas in the cortex at the sites of ischemia related to the initial MCA occlusion and in parts of the basal ganglia. Perfusion imaging revealed elevated cerebral blood flow in these areas, and electroencephalogram showed bilateral high-amplitude slow waves. Thus, treatments that included strict blood pressure control and taking antiepileptic drugs were initiated on the basis of the suspicion of CHS or NCSE. By the 21st hospitalization day, improvement in the signs of CHS was revealed by MRI. Moreover, motor dysfunction and impaired consciousness had also almost completely resolved, but higher cortical dysfunction remained.
Conclusion: In cases where prolonged consciousness disorder inconsistent with the progress and extent of thrombectomy is observed, CHS or NCSE should be considered in the differential diagnoses, and appropriate scans should be performed for further examination.
