Anesth Pain Med.  2016 Oct;11(4):362-365. 10.17085/apm.2016.11.4.362.

Hemisphere cerebral infarction after total laparoscopic hysterectomy in the Trendelenburg position: A case report

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea. hyunkyolim@yonsei.ac.kr

Abstract

Perioperative stroke can lead to mortality or serious disability and usually occurs in patients undergoing cardiac, vascular, or neurologic surgery; it is rare in gynecological surgery. We report the case of a patient who suffered life-threatening cerebral infarction after elective laparoscopic hysterectomy. During the surgery, the patient was placed in the Trendelenburg position. On postoperative day one, the patient was diagnosed with right hemisphere cerebral infarction; brain computed tomographic angiography showed proximal right internal carotid artery occlusion. Decompressive craniectomy was performed to resolve brain swelling, but the patient died 10 days later.

Keyword

Cerebral infarction; Laparoscopic hysterectomy; Stroke; Trendelenburg position

MeSH Terms

Angiography
Brain
Brain Edema
Carotid Artery, Internal
Cerebral Infarction*
Decompressive Craniectomy
Female
Gynecologic Surgical Procedures
Head-Down Tilt*
Humans
Hysterectomy*
Mortality
Stroke

Figure

  • Fig. 1 Computed tomography angiography showing stenosis of the right proximal common carotid artery (arrow head) and total occlusion of the right internal carotid artery at the proximal common carotid artery bifurcation with poorly visualized right anterior and middle cerebral artery (arrow).

  • Fig. 2 The right internal carotid artery was not seen at the C2 cervical vertebra level (arrow).

  • Fig. 3 Pre and postcontrast CT showing right cerebral hemisphere infarction with midline shift.


Reference

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