Early-onset acute mca infarcti̇on after spi̇nal anesthesia: A rare case

Abstract

Acute ischemic stroke is an uncommon but clinically important perioperative complication. Establishing causality between anesthetic technique and stroke is often difficult because perioperative cerebrovascular events are multifactorial and may be influenced by patient-related vascular risk factors. We report a 74-year-old woman with hypertension who developed sudden dysarthria, left facial asymmetry, and left-sided weakness 20 minutes after elective flexible ureterorenoscopy performed under spinal anesthesia. Intraoperative hemodynamic parameters remained stable, and no hypoxia, bradycardia, hypotension, or loss of consciousness was observed. Emergency cranial computed tomography excluded intracranial hemorrhage, and diffusion-weighted magnetic resonance imaging demonstrated acute ischemic infarction in the right middle cerebral artery territory. Cranial computed tomography angiography did not show major intracranial arterial occlusion, while carotid imaging revealed calcified atherosclerotic plaques with mild stenosis. Intravenous alteplase was administered within the therapeutic time window after neurological evaluation. The patient showed substantial neurological improvement during follow-up and was discharged on postoperative day 6 with mild residual left lower extremity weakness. This case should be interpreted as an acute MCA infarction occurring shortly after spinal anesthesia rather than as evidence of a direct causal relationship. It highlights the importance of prompt recognition of new neurological symptoms, rapid neuroimaging, and multidisciplinary management in the early postoperative period, particularly in elderly patients with vascular risk factors.

Keywords

• Spinal Anesthesia
• Acute Ischemic Stroke
• MCA Infarction
• Postoperative Complication
• Flexible Ureterorenoscopy

Supporting Institution

The authors received no financial support for this study.

Ethical Statement

The authors declare that the study was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from the patient for the publication of this case report and any accompanying images.

Thanks

The authors have no acknowledgements to declare.

Spinal Anestezi Sonrası Erken Dönemde Gelişen Akut MCA İnfarktı: Nadir Bir Olgu

Abstract

Santral bloklar, sistemik ilaç gereksinimini azaltması, kardiyopulmoner stabiliteyi koruması, intraoperatif hasta kooperasyonuna olanak sağlaması ve postoperatif iyileşme sürecine katkıda bulunması nedeniyle birçok cerrahi girişimde güvenle tercih edilmektedir. Bu olgu sunumunda, ürolitiyazis nedeniyle spinal anestezi altında elektif koşullarda fleksibl üreterorenoskopi (URS) uygulanan bir hastada erken postoperatif dönemde gelişen akut orta serebral arter (MCA) enfarktı tanısı ve acil müdahalesi klinik açıdan ele alınmıştır. İntraoperatif dönemde hemodinamik parametreleri stabil seyreden hastada, postoperatif 20. dakikada ani başlangıçlı dizartri, fasiyal asimetri ve hemipleji ile karakterize akut nörolojik defisit ortaya çıkmış; acil nörogörüntüleme ile iskemik inme tanısı doğrulanmıştır. Spinal anestezi, özellikle erken nörolojik değişikliklerin fark edilmesini kolaylaştırması ve bilinç değerlendirmesine imkân tanıması açısından bu olguda önemli bir avantaj sağlamıştır. Bu sayede, terapötik zaman penceresi içerisinde intravenöz trombolitik tedavi uygulanmış ve takipte belirgin nörolojik iyileşme elde edilmiştir. Bu olgu, spinal blok altında gerçekleştirilen kısa süreli ve düşük riskli endoürolojik girişimler sonrasında dahi akut iskemik inme gelişebileceğini göstermekte; özellikle ileri yaş ve serebrovasküler risk faktörlerine sahip hastalarda erken tanı, hızlı değerlendirme ve zamanında tedavinin önemine dikkat çekmektedir.

Keywords

• Spinal Anestezi
• Akut İskemik İnme
• MCA Enfarktı
• Postoperatif Komplikasyon
• Fleksibl Üreterorenoskopi

Supporting Institution

Yazarlar bu çalışma için hiçbir finansal destek almadılar.

Ethical Statement

Yazarlar, çalışmanın Helsinki Deklarasyonu'na uygun olarak yürütüldüğünü beyan ederler. Bu vaka raporunun ve beraberindeki görüntülerin yayınlanması için hastadan bilgilendirilmiş onam alındı.

Thanks

Yazarların beyan edeceği bir teşekkür bulunmamaktadır.

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