Hypertension, vascular headaches, and seizures after carotid endarterectomy. Case report and therapeutic considerations.
The following three unusual complications of carotid endarterectomy developed in a 64-year-old woman: vascular headaches, delayed hypertension, and seizures. beta-Blockade with propranolol hydrochloride had no beneficial effect on either the hypertension or the headaches. Peripheral alpha-blockade with prazosin hydrochloride resulted in prompt improvement in the patient's condition. Altered autonomic vascular control secondary to carotid sinus trauma is proposed as a possible causative mechanism for all three complications. The therapeutic implications are discussed. Based on this experience, we would caution against the use of unopposed beta-blockade in this setting and suggest that the role of prazosin in the initial management of postendarterectomy hypertension and vascular headache be explored.
D002339:Carotid Arteries / Q000601:surgery*; D004691:Endarterectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology*; D008875:Middle Aged; D010634:Phenobarbital / Q000627:therapeutic use; D011224:Prazosin / Q000627:therapeutic use; D011433:Propranolol / Q000627:therapeutic use; D012640:Seizures / Q000188:drug therapy / Q000209:etiology*; D014653:Vascular Headaches / Q000188:drug therapy / Q000209:etiology*
D011433:Propranolol; D011224:Prazosin; D010634:Phenobarbital