Rare complication of carotid stenting: New-onset refractory status epilepticus: A study of five patients

Introduction: New-onset refractory status epilepticus (NORSE) is uncommon and almost 50% of cases are cryptogenic. We report the rare development of NORSE following carotid artery stenting (CAS), a procedure which is increasingly being used to treat the carotid stenosis. Materials and Methods: Patie...

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Bibliographic Details
Published in:Annals of the Indian Academy of Neurology 2019-04, Vol.22 (2), p.210-212
Main Authors: Deshmukh, Narayan, Singh, Rakeshsingh, Lalla, Rakesh, Karapurkar, Anil, Khadilkar, Satish
Format: Article
Language:English
Subjects:
Antiepileptic agents
Blood pressure
Care and treatment
Carotid arteries
Carotid artery
Carotid artery stenting
cerebral hyperperfusion syndrome
Cerebral infarction
Convulsions & seizures
Diabetes
Diabetes mellitus
Epilepsy
Gliosis
Health aspects
Hypertension
Medical imaging
Medical research
new-onset refractory status epilepticus
Paresis
Prevention
Short Communications
Status epilepticus
Stenosis
Stents
Stroke
Syncope
Territory
Veins & arteries
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Summary:Introduction: New-onset refractory status epilepticus (NORSE) is uncommon and almost 50% of cases are cryptogenic. We report the rare development of NORSE following carotid artery stenting (CAS), a procedure which is increasingly being used to treat the carotid stenosis. Materials and Methods: Patients who developed NORSE following CAS for the prevention of stroke over a period of 5 years were analyzed retrospectively. The degree of internal carotid artery stenosis (ICA) was estimated as per the NASCET criteria. Results: We analyzed five patients (age: 56-83 years). NORSE was reported within 30 min to 14 days post-CAS. Status epilepticus was focal in two patients, generalized in two, and one had nonconvulsive status epilepticus. All patients were treated with multiple antiepileptic drugs. Four patients recovered and survived and one succumbed. Two patients had comorbid hypertension and two had diabetes and hypertension. Four patients had hemiparesis due to the contralateral middle cerebral artery territory infarction and one patient had syncope. Two patients had postinfarction gliosis. Conclusions: We report a new cause of NORSE, following CAS. Stroke resulting in gliosis and cerebral hyperperfusion syndrome are the proposed mechanisms.
ISSN:0972-2327
1998-3549
DOI:10.4103/aian.AIAN_445_18