Hypoxic-Ischemic Encephalopathy Following Carotid Endarterectomy

Figure. Diffusion weighted MR images (DWI) at 3 days after admission (A) show multiple discrete cortical and subcortical hyperintenselesions and diffuse cortical hyperintensity (arrow) in the left middle cerebral artery (MCA) territory. MR angiography (B) shows severe stenosis (arrow) at the bifurcation of the left common carotid artery. Color-coded duplex sonography (C) shows significant narrowing at the junction between the left common carotid artery and the proximal internal carotid artery with increased peak systolic velocity of 329 cm/s. Carotid endarterectomy (CEA) was done on the stenosed segment 10 days post admission. The patient became comatose after cardiac arrest 2 days after CEA. Follow-up DWI while in coma (D) shows bright diffuse cortical hyperintensity in the whole brain except the left MCA territory.