title: [Postoperative dissection of the vertebral artery in two steps].
abstract: The diagnosis of perioperative vertebral artery dissection can be difficult because of non-specific clinical signs. We report a case revealed by a tegmento-thalamic stroke after an abdominal second surgical look. The interest of this observation is related to a particular evolution in two steps separated by a 2-month-interval and an intercurrent cervical manipulation. After the second anesthesia, neck pain associated with a third cranial nerve palsy and a supranuclear ophtalmoplegia revealed a tegmento-thalamic ischemic stroke due to vertebral artery dissection. We discuss here the different factors possibly involved in the pathophysiology of postoperative vertebral artery dissection: positioning, cervical manipulation, subclavian central venous access and cisplatin toxicity. Vertebral artery dissection should be discussed in case of postoperative neck pain, especially with non-typical symptomatology.
authors.affiliation: Service d'anesthésie réanimation, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raymond, 42270 Saint-Priest-en-Jarez, France. Electronic address: jean-yves.bien@wanadoo.fr.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Bien
authors.affiliation: Service d'anesthésie réanimation, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raymond, 42270 Saint-Priest-en-Jarez, France.
authors.forename: J
authors.initials: J
authors.lastname: Morel
authors.affiliation: Service de neurologie, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raymond, 42270 Saint-Priest-en-Jarez, France.
authors.forename: S
authors.initials: S
authors.lastname: Demasles
authors.affiliation: Service de chirurgie digestive et cancérologique, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raymond, 42270 Saint-Priest-en-Jarez, France.
authors.forename: K
authors.initials: K
authors.lastname: Abboud
authors.affiliation: Service d'anesthésie réanimation, hôpital Nord, CHU de Saint-Étienne, avenue Albert-Raymond, 42270 Saint-Priest-en-Jarez, France.
authors.forename: S
authors.initials: S
authors.lastname: Molliex
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D001063:Appendiceal Neoplasms / Q000150:complications / Q000601:surgery; D002545:Brain Ischemia / Q000209:etiology / Q000628:therapy; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D006801:Humans; D020393:Manipulation, Spinal; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology / Q000628:therapy; D015840:Oculomotor Nerve Diseases / Q000209:etiology / Q000628:therapy; D011183:Postoperative Complications / Q000175:diagnosis* / Q000628:therapy; D020521:Stroke / Q000209:etiology / Q000628:therapy; D013494:Supranuclear Palsy, Progressive / Q000209:etiology / Q000628:therapy; D020217:Vertebral Artery Dissection / Q000175:diagnosis* / Q000628:therapy
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin
keywords: Accident vasculaire cérébral; Anesthésie générale; Cervical manipulation; Cervicalgie; Cysplatin; Cysplatine; Dissection d’artère vertébrale; General anesthesia; Manipulation cervicale; Neck pain; Stroke; Vertebral artery dissection