TY - JOUR
T1 - Delayed cerebral infarct following anterior cervical diskectomy and fusion
AU - Graffeo, Christopher S.
AU - Puffer, Ross C.
AU - Wijdicks, Eelco F.M.
AU - Krauss, William E.
N1 - Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Background: Ischemic stroke following anterior cervical diskectomy and fusion (ACDF) is an exceedingly rare complication. There are only three previous cases focusing on this problem in the literature; here, we present the fourth case. Case Description: A patient, cared for at an outside institution, developed a delayed ischemic stroke 3 days following an ACDF. This complication was attributed to carotid manipulation precipitating vascular injury in the setting of multiple comorbid vascular and coagulopathic risk factors, including previously undiagnosed carotid atherosclerosis, a prior history of pulmonary embolus requiring Warfarin anticoagulation (held perioperatively), acute dehydration, and atrial fibrillation. Conclusions: This case demonstrates the importance of focused history and examination in appropriate patients prior to ACDF, with special consideration given to the significance of age, comorbidities including coagulopathy and arrhythmia, and potential underlying vascular disease as markers for increased risk of perioperative thrombotic stroke associated with carotid manipulation. Patients at higher risk warrant comprehensive preoperative assessment, including medical evaluation, carotid imaging, and consideration for alternative surgical approaches. Copy; 2016 Surgical Neurology International | Published by Wolters Kluwer - Medknow.
AB - Background: Ischemic stroke following anterior cervical diskectomy and fusion (ACDF) is an exceedingly rare complication. There are only three previous cases focusing on this problem in the literature; here, we present the fourth case. Case Description: A patient, cared for at an outside institution, developed a delayed ischemic stroke 3 days following an ACDF. This complication was attributed to carotid manipulation precipitating vascular injury in the setting of multiple comorbid vascular and coagulopathic risk factors, including previously undiagnosed carotid atherosclerosis, a prior history of pulmonary embolus requiring Warfarin anticoagulation (held perioperatively), acute dehydration, and atrial fibrillation. Conclusions: This case demonstrates the importance of focused history and examination in appropriate patients prior to ACDF, with special consideration given to the significance of age, comorbidities including coagulopathy and arrhythmia, and potential underlying vascular disease as markers for increased risk of perioperative thrombotic stroke associated with carotid manipulation. Patients at higher risk warrant comprehensive preoperative assessment, including medical evaluation, carotid imaging, and consideration for alternative surgical approaches. Copy; 2016 Surgical Neurology International | Published by Wolters Kluwer - Medknow.
KW - Anterior cervical diskectomy and fusion
KW - carotid disease
KW - cerebral infarct
KW - screening
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U2 - 10.4103/2152-7806.191022
DO - 10.4103/2152-7806.191022
M3 - Article
AN - SCOPUS:85027287320
SN - 2152-7806
VL - 7
JO - Surgical Neurology International
JF - Surgical Neurology International
IS - 1
M1 - 86
ER -