Perioperative massive cerebral stroke in thoracic patients: Report of three cases

Abstract

Background: Perioperative stroke is a rare but devastating complication. The risk factors for massive cerebral stroke in surgical patients include older age, male sex, prior cerebrovascular disease, hypertension, renal failure, smoking, diabetes mellitus, and atrial fibrillation.

Case summary: We describe two cases of perioperative massive cerebral stroke following thoracic surgery and one case following bronchoscopy. Neurologic symptoms, including changes in mental status and hemiplegia, occurred within 10 h after surgery in the three patients. All three patients died after the surgery.

Conclusion: Perioperative massive cerebral stroke may be more likely to occur in thoracic surgical patients if there are pre-existing factors including previous stroke, hypotension, and hypoxemia. Sufficient pain control after surgery and timely neurology consultation and management are helpful for the diagnosis and control of stroke in high-risk patients.

Keywords: Anesthesia; Case report; Literature review; Massive cerebral stroke; Perioperative; Thoracic surgery.

Figure 1

Magnetic resonance and computed tomography images of case 1. A-C: Magnetic resonance imaging (A and B) and angiography (C) performed 4 h after surgery showed right cerebral infarction, occlusion of right internal carotid artery (ICA), and severe stenosis of left ICA; D-F: Computed tomography (CT) scans performed 1 d after surgery showed right cerebral infarction; G-I: CT scans performed 4 d after surgery showed right cerebral infarction progression.