Abstract
Purpose
Ischemic brainstem stroke resulting from occlusion of the basilar artery during cervical spine surgery in a previously asymptomatic patient is a rare event. We report the development of a large ischemic brainstem stroke, resulting from occlusion of the basilar artery during anterior cervical discectomy, in a patient without previous neurological deficit, or signs of vertebrobasilar insufficiency.
Clinical features
A 55-yr-old, diabetic and hypertensive male who developed a cervical spine infection, underwent surgery for anterior discectomy at C5-C6. During the 2.5-hr long procedure the patient was lying supine with his neck hyperextended. Except for a temporary reduction in systolic blood pressure, the intraoperative course was uneventful. At the end of surgery the patient remained unconscious with flaccid paralysis in all extremities, fixed pinpoint pupils, low respiratory rate, and no response to painful stimuli. Naloxone administration did not improve the clinical picture, while brain computed tomography showed a large brainstem and cerebellar stroke, implicating basilar artery occlusion. The patient died five days later from stroke complications. Intraoperative surgical manipulation with a severely inflamed vertebral system, as well as prolonged neck hyperextension occluding the blood flow of vertebrobasilar arteries might have contributed to fatal brainstem stroke in this patient.
Conclusion
Neck surgery carries a potential risk for posterior circulation stroke, and this report heightens awareness of this rare, but serious complication.
Résumé
Objectif
Un accident ischémique du tronc cérébral, résultat de ľocclusion de ľartère basilaire pendant une opération de la colonne cervicale chez un patient auparavant asymptomatique, est un événement rare. Nous présentons le cas ďun important accident ischémique du tronc cérébral causé par ľocclusion de ľartère basilaire pendant une discectomie cervicale antérieure chez un patient sans déficit neurologique ou signes ďinsuffisance vertébro-basilaire connus.
Éléments cliniques
Un homme de 55 ans, diabétique et hypertendu, ayant une infection de la colonne cervicale, a subi une discectomie antérieure en C5-C6. Pendant ľopération de 2,5 h, le patient était en décubitus dorsal avec le cou en hyperextension. Ľopération s’est déroulée sans incident, sauf une réduction temporaire de la tension artérielle systolique. À la fin de ľopération, le patient est demeuré inconscient et présentait une paralysie flasque aux extrémités, des micropupilles fixes, une fréquence respiratoire faible et aucune réaction aux stimuli douloureux. Ľadministration de naloxone n’a pas corrigé la situation et la tomodensitométrie du cerveau a montré un accident vasculaire important du tronc cérébral et du cervelet consécutif à ľocclusion de ľartère basilaire. Le patient est décédé cinq jour plus tard des complications de ľaccident vasculaire. Les manipulations chirurgicales peropératoires ďun système vertébral sévèrement enflammé et ľhyperextension prolongée du cou, bloquant le débit sanguin des artères vertébrobasilaires, ont pu contribuer à ľaccident vasculaire fatal du tronc cérébral.
Conclusion
Ľopération du cou comporte un risque potentiel ďaccident circulatoire postérieur et notre article présente cette complication rare, mais grave.
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Tsai, YF., Doufas, A.G., Huang, CS. et al. Postoperative coma in a patient with complete basilar syndrome after anterior cervical discectomy. Can J Anesth 53, 202–207 (2006). https://doi.org/10.1007/BF03021828
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DOI: https://doi.org/10.1007/BF03021828