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Cerebral Hyperperfusion Post-CEA — FRCA Final MCQ

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HardGeneral AnaesthesiaCerebral Hyperperfusion Post-CEAFRCA Final

A 65-year-old man undergoes carotid endarterectomy. After unclamping, he develops ipsilateral headache and hypertension (BP 210/120). CT shows no haemorrhage. This is most likely:

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Correct answer: B — Tension headache

Cerebral hyperperfusion syndrome occurs after CEA when blood flow to a previously hypoperfused hemisphere suddenly increases. It presents with ipsilateral headache, hypertension, seizures, and if untreated, intracerebral haemorrhage. Risk is highest in patients with severe contralateral disease and poor collateral flow. Treatment: strict BP control (target SBP 100-140 mmHg) with labetalol or clevidipine.

Reference: NICE – 2019 – NG128 Stroke; RCOA – 2023 – Vascular anaesthesia