title: Are limb-shaking transient ischemic attacks a risk factor for postendarterectomy hemorrhage? Case report and literature review.
abstract: Postoperative intracerebral hemorrhage occurs in about 0.5% of all carotid endarterectomies. There are no recognized risk factors for this complication. We report on a 74-year-old woman with right sided limb-shaking transient ischemic attacks and severe stenosis of the left internal carotid artery. She suffered a fatal intracerebral hemorrhage 11 days after endarterectomy. This case prompted a review of the literature to determine if limb-shaking transient ischemic attacks might be a risk factor for postoperative intracerebral hemorrhage. We propose that patients with limb-shaking transient ischemic attacks have loss of vasomotor reactivity placing them at high risk for carotid reperfusion syndrome and hemorrhage into the revascularized territory.
authors.affiliation: Medical College of Georgia - Neurology, Augusta, GA 30909, USA. jswitzer@mcg.edu
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Switzer
authors.forename: Fenwick T
authors.initials: FT
authors.lastname: Nichols
mesh_terms: D000368:Aged; D000792:Angiography; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000503:physiopathology; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D012307:Risk Factors; D014202:Tremor / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D017585:Ultrasonography, Doppler, Transcranial