CT perfusion abnormalities after carotid endarterectomy help make the diagnosis of reversible cerebral vasoconstriction syndrome

ABSTRACT Acute neurologic deficits in the postoperative period after carotid endarterectomy (CEA) can prompt extensive diagnostic evaluation. Reversible cerebral vasoconstriction syndrome (RCVS) is an underrecognized cause of acute neurologic deficit following CEA. We present a case of RCVS in an 84-year-old male patient who experienced left limb weakness following CEA, prompting multiple code stroke activations. This case is novel because obtained CT perfusion imaging demonstrated abnormalities which have not been previously described in RCVS. These findings, combined with cerebral angiography, lead to rapid diagnosis and the delivery of intra-arterial vasodilator therapy. There was subsequent resolution of symptoms and radiologic abnormalities.