Cerebral embolism during revision arthroplasty of the hip.
Cerebral embolism poses one of the most perplexing problems in cerebrovascular disease; fat emboli and marantic air emboli occur occasionally. However, the most common cause for a cerebral embolism is degenerative changes in the central arteries. The authors report the case of a 75-year-old female suffering from ischemic cerebrovascular disease of the left dominant hemisphere during a revision arthroplasty of the right hip (cementless Austin Moore hemiarthroplasty to a cemented Charnley total hip replacement); a cement gun was used to introduce the cement; both the induction of anesthesia and the surgical procedure were uneventful. The patient awoke slowly, and when awake she showed a combination of contralateral hemiplegia, and right hemianesthesia with global aphasia; the CT scan showed an ischemic lesion in the territory of the middle cerebral artery; during the following two weeks the patient showed complete recovery from the clinical syndrome. This complication must be recognized by every orthopedic surgeon, and a high clinical index of suspicion remains essential to early diagnosis.
Rodriguez-Merchan
E C
EC
Traumatology Service, La Paz Hospital, Madrid, Spain.
Comin-Gomez
J A
JA
Martinez-Chacon
J L
JL
D000368:Aged; D000768:Anesthesia, General / Q000379:methods; D005260:Female; D006622:Hip Prosthesis / Q000379:methods*; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000000981:diagnostic imaging / Q000209:etiology*; D007431:Intraoperative Complications / Q000209:etiology*; D011859:Radiography; D012075:Remission, Spontaneous