title: [A cerebral watershed infarction after general anaesthesia in a patient with increased anti-cardiolipin antibody level].
abstract: During the first generalised epileptic attack, a patient suffered a humerus fracture which necessitated an operation. This patient also had a history of spontaneous lung emboli and an elevated anti-cardiolipin plasma level for which coumarin was prescribed but was stopped preoperatively. After induction of general anaesthesia for a total shoulder arthroplasty, the patient became hypotensive and the bispectral index recorded perioperatively dropped to 0. Postoperatively, the patient developed signs of a unilateral borderzone cerebral infarct in the area of the medial cerebral artery. The possible pathomechanisms involved are discussed. In cases of known cerebral pathology intraoperative hypotension should be avoided by at all costs. Patients with increased anti-cardiolipin antibody levels and who suffer from epileptic attacks have an increased risk of thromboembolic events.
authors.affiliation: Afdeling Anesthesiologie, Erasmus MC, Rotterdam, Netherlands. serge.verbrugge@12move.nl
authors.forename: S J C
authors.initials: SJ
authors.lastname: Verbrugge
authors.forename: M
authors.initials: M
authors.lastname: Klimek
authors.forename: J
authors.initials: J
authors.lastname: Klein
mesh_terms: D000768:Anesthesia, General; D000925:Anticoagulants / Q000627:therapeutic use; D001178:Arthroplasty; D001323:Autoantibodies / Q000032:analysis / Q000276:immunology*; D001780:Blood Coagulation Tests; D002308:Cardiolipins / Q000276:immunology*; D003374:Coumarins / Q000627:therapeutic use; D004562:Electrocardiography / Q000187:drug effects; D006439:Hemodynamics; D006801:Humans; D006810:Humeral Fractures / Q000601:surgery; D020244:Infarction, Middle Cerebral Artery / Q000209:etiology*; D007431:Intraoperative Complications / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012782:Shoulder / Q000601:surgery
chemical_list: D000925:Anticoagulants; D001323:Autoantibodies; D002308:Cardiolipins; D003374:Coumarins; C030123:coumarin