6.5.2 Post-endarterectomy headache

Identification: Male patient, 58 years old, with hypertension, type 2 diabetes, dyslipidemia, and a smoking history of 20 pack-years. He has a history of peripheral arterial occlusive disease (PAOD) and underwent left internal carotid artery endarterectomy 72 hours ago. Clinical History: The patient was admitted for carotid endarterectomy due to symptomatic 80% stenosis of the left internal carotid artery, with previous episodes of transient ischemic attack (TIA) characterized by amaurosis fugax and right-sided hemiparesis. The surgery was performed without immediate complications, with good cerebral reperfusion confirmed by intraoperative Doppler. Current Situation: 48 hours post-surgery, the patient began to report severe, holocranial, pulsatile headache with progressive worsening, associated with nausea and photophobia. There were no focal neurological deficits, fever, or changes in consciousness. Blood pressure was controlled (130/80 mmHg), and there were no signs of infection at the surgical site. Complementary Exams: Cranial Computed Tomography (CT): No evidence of bleeding, infarction, or cerebral edema. Carotid CT Angiography: Patency of the left internal carotid artery, with no signs of thrombosis or dissection. Lumbar Puncture: Clear cerebrospinal fluid (CSF), with elevated opening pressure (28 cmH₂O), normal proteins and glucose, without pleocytosis.