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Cerebral embolism during revision arthroplasty of the hip
E C Rodriguez-Merchan1, J A Comin-Gomez, J L Martinez-Chacon
1Traumatology Service, La Paz Hospital, Madrid, Spain.
Insights
Cerebral embolism, often from arterial degeneration, can occur during hip replacement surgery. Early recognition by orthopedic surgeons is crucial for prompt diagnosis and management of this cerebrovascular complication.
Area of Science:
- Neurology
- Orthopedic Surgery
- Vascular Disease
Background:
- Cerebral embolism is a significant concern in cerebrovascular disease.
- While fat and air emboli are known, arterial degenerative changes are a common cause.
- Orthopedic procedures, particularly hip arthroplasty, carry a risk of cerebrovascular complications.
Abstract:
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.