Abstract
A 56-year-old man underwent surgery under general anesthesia at another hospital to remove an anterior cervical plate 2 years after fusion surgery. He developed hypotension immediately after the operation and was transferred to our hospital because of poor recovery from anesthesia and postoperative agitation. Examination revealed akinetic mutism and mild right hemiplegia. Diffusion-weighted magnetic resonance imaging showed an infarction extending from the head of the caudate nucleus to the basal ganglia, and magnetic resonance angiography revealed an irregular wall of the left internal carotid artery (ICA) at the first segment and occlusion of the anterior cerebral artery at the A1 segment. Subsequent computed tomographic angiography showed arterial dissection extending from the first segment of the left ICA to the external carotid artery. Diagnosis was surgery-related ICA dissection and subsequent embolic cerebral infarction, and antiplatelet therapy was started. The patient showed no worsening of symptoms thereafter and was discharged home fully ambulatory. Although vascular complications after anterior cervical spine surgery are very rare, the possibility of arterial dissection-related complications should be considered, even after relatively short-lasting surgery, as reported herein.
