# Role of Point-of-Care Cerebral Ultrasonography in Determining the Etiology of Post-carotid Endarterectomy Deficit: A Case Report

## TL;DR

A patient developed a severe neurological issue after carotid surgery, and bedside brain ultrasound helped identify a dangerous brain bleed.

## Contribution

This case highlights the use of point-of-care cerebral ultrasonography in diagnosing post-surgery neurological deficits.

## Key findings

- Cerebral ultrasound at the bedside detected intracerebral hemorrhage after carotid endarterectomy.
- The hemorrhage was likely due to reperfusion injury and loss of cerebral autoregulation.
- The complication had a high mortality rate and required neuroresuscitation.

## Abstract

Carotid revascularization surgery is notorious for its neurological morbimortality. We report the case of a 74-year-old hypertensive patient, who underwent left internal carotid artery endarterectomy for a 90% stenosis under general anesthesia, presenting in the immediate postoperative period with right hemiplegia without consciousness disorders. Evaluation by cerebral ultrasound at bedside led to suspicion of intracerebral hemorrhage, which was confirmed by cerebral CT scan. The patient was treated by neuroresuscitation measures in the absence of the possibility of surgical intervention. This hemorrhage may be explained by a reperfusion injury due to the loss of cerebral autoregulation of these vessels, the loss of controlling blood pressure, and the use of heparin in vascular surgery. This is a rare but fatal complication with a high mortality rate.