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Tanaskovic S, Cimbaljevic N, Petrovic J, Ljatifi E, Antonijevic M, Neskovic M, Ostojic A, Ilijevski N. Todd's paralysis due to hyperperfusion syndrome after carotid endarterectomy mimicking postoperative stroke. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:521-525. [PMID: 37335281 DOI: 10.23736/s0021-9509.23.12720-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Todd's paralysis is a neurological deficit that is observed in <10% of patients following epileptic seizures. Cerebral hyperperfusion syndrome (CHS) is a rare complication following carotid endarterectomy (CEA), seen in 0-3% of the patients, characterized by focal neurological deficit, headache, disorientation, and sometimes seizures. In this case report, we present a case of CHS after CEA followed by seizures and Todd's paralysis that mimicked postoperative stroke. A 75-year-old female patient was admitted for CEA of the right internal carotid artery, following a transient ischemic attack two months prior. Four hours after CEA with graft interposition, the patient suffered a temporary weakness of the left arm and leg followed by generalized spasms within a few seconds. CT angiography showed regular patency of the carotid arteries and the graft, and brain CT showed no sign of oedema, ischemia or hemorrhage. However, left-sided hemiplegia occurred following the seizure, and the patient suffered four more seizures over the next 48 hours, with persisting hemiplegia. On the second postoperative day, the motor skills of the left side fully recovered, and the patient was communicative, and of orderly mental status. Brain CT performed on the third postoperative day showed entire right hemisphere oedema. A moderate hemiparesis with seizures as a consequence of CHS after CEA has been described, however in all cases with seizures and hemiplegia, the underlying cause was always a verified stroke or intracerebral hemorrhage. This case highlights the importance of considering Todd's paralysis in patients with seizures after CEA due to CHS and prolonged periods of hemiplegia after the seizures.
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Affiliation(s)
- Slobodan Tanaskovic
- Vascular Surgery Clinic, Dedinje Institute for Cardiovascular Diseases, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Cimbaljevic
- Vascular Surgery Clinic, Dedinje Institute for Cardiovascular Diseases, Belgrade, Serbia
| | - Jovan Petrovic
- Vascular Surgery Clinic, Dedinje Institute for Cardiovascular Diseases, Belgrade, Serbia -
| | - Enes Ljatifi
- Vascular Surgery Clinic, Dedinje Institute for Cardiovascular Diseases, Belgrade, Serbia
| | - Mirjana Antonijevic
- Department of Neuroangiology, Vascular Surgery Clinic, Dedinje Institute for Cardiovascular Diseases, Belgrade, Serbia
| | - Maja Neskovic
- Department of Neuroangiology, Vascular Surgery Clinic, Dedinje Institute for Cardiovascular Diseases, Belgrade, Serbia
| | - Aleksandra Ostojic
- Department of Non-Invasive Radiological Diagnostics, Dedinje Institute for Cardiovascular Diseases, Belgrade, Serbia
| | - Nenad Ilijevski
- Vascular Surgery Clinic, Dedinje Institute for Cardiovascular Diseases, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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