PMID- 26459699
OWN - NLM
STAT- MEDLINE
DCOM- 20160520
LR  - 20161126
IS  - 1878-8769 (Electronic)
IS  - 1878-8750 (Linking)
VI  - 85
DP  - 2016 Jan
TI  - Perioperative Bioccipital Watershed Strokes in Bilateral Fetal Posterior Cerebral 
      Arteries During Spinal Surgery.
PG  - 367.e17-21
LID - S1878-8750(15)01299-1 [pii]
LID - 10.1016/j.wneu.2015.09.098 [doi]
AB  - BACKGROUND: Vision loss due to cerebral infarction during spinal surgery is less 
      described. Intraoperative hypotension would be a leading cause. Patients with 
      variation of the circle of Willis could be more prone to present stroke in this 
      context, but reports are lacking to sustain the theory. Bilateral occipital 
      watershed ischemic strokes have never been described before. We report the case 
      of a patient with a fetal origin of both posterior cerebral arteries (PCAs), 
      presenting this particular anatomic stroke following lumbar laminectomy surgery 
      for spinal stenosis during which intraoperative hypotension was observed. We 
      discuss how this common anomaly associated with intraoperative hypotension could 
      have promoted this serious complication. CASE DESCRIPTION: A 55-year-old man woke 
      up with cortical blindness after he had undergone lumbar surgery during which a 
      marked decrease in blood pressure had occurred. Magnetic resonance imaging 
      revealed bilateral symmetric infarctions of the occipital lobes in the distal 
      territory of both PCAs and smaller anterior watershed ischemic strokes, 
      suggesting a hemodynamic mechanism. Extended investigations, including 
      conventional angiography, failed to find any cause of stroke but revealed 
      bilateral fetal PCAs supplied by internal carotid arteries only. Two years later, 
      the patient has not recovered and remains severely visually impaired. 
      CONCLUSIONS: The standing hypothesis would be posterior low-flow infarctions 
      resulting from intraoperative hypotension on a variation of the circle of Willis 
      more prone to decrease in cerebral blood flow. Moreover, this case supports the 
      hypothesis of vascular insufficiency due to intraoperative hypotension as cause 
      of stroke during spinal surgery.
CI  - Copyright (c) 2016 Elsevier Inc. All rights reserved.
FAU - Mione, Gioia
AU  - Mione G
AD  - Department of Neurology, Stroke Unit, University Hospital of Nancy, France.
FAU - Pische, Guillaume
AU  - Pische G
AD  - Department of Neurology, Stroke Unit, University Hospital of Nancy, France.
FAU - Wolff, Valerie
AU  - Wolff V
AD  - Department of Neurology, Stroke Unit, University Hospital of Strasbourg, France.
FAU - Tonnelet, Romain
AU  - Tonnelet R
AD  - Department of Neuroradiology, University Hospital of Nancy, France.
FAU - Humbertjean, Lisa
AU  - Humbertjean L
AD  - Department of Neurology, Stroke Unit, University Hospital of Nancy, France.
FAU - Richard, Sebastien
AU  - Richard S
AD  - Department of Neurology, Stroke Unit, University Hospital of Nancy, France. 
      Electronic address: s.richard@chu-nancy.fr.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20151013
PL  - United States
TA  - World Neurosurg
JT  - World neurosurgery
JID - 101528275
SB  - IM
MH  - Anesthesia, General/*adverse effects
MH  - Blindness, Cortical/*etiology
MH  - Blood Pressure/drug effects
MH  - Cerebral Angiography
MH  - Cerebrovascular Circulation
MH  - Circle of Willis/diagnostic imaging
MH  - Hemodynamics
MH  - Humans
MH  - Hypotension/chemically induced/*complications/etiology
MH  - Infarction, Posterior Cerebral Artery/complications/*diagnosis/*etiology
MH  - Laminectomy/*adverse effects
MH  - Lumbar Vertebrae
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Occipital Lobe/*blood supply
MH  - Perioperative Period
MH  - Posterior Cerebral Artery/*abnormalities
MH  - Spinal Stenosis/*surgery
OTO - NOTNLM
OT  - Cerebral watershed infarction
OT  - Circle of Willis
OT  - Intraoperative hypotension
OT  - Perioperative stroke
OT  - Posterior cerebral artery
OT  - Spinal surgery
OT  - Vision loss
EDAT- 2015/10/16 06:00
MHDA- 2016/05/21 06:00
CRDT- 2015/10/14 06:00
PHST- 2015/09/03 00:00 [received]
PHST- 2015/09/25 00:00 [revised]
PHST- 2015/09/25 00:00 [accepted]
PHST- 2015/10/14 06:00 [entrez]
PHST- 2015/10/16 06:00 [pubmed]
PHST- 2016/05/21 06:00 [medline]
AID - S1878-8750(15)01299-1 [pii]
AID - 10.1016/j.wneu.2015.09.098 [doi]
PST - ppublish
SO  - World Neurosurg. 2016 Jan;85:367.e17-21. doi: 10.1016/j.wneu.2015.09.098. Epub 
      2015 Oct 13.