Nilüfer ARISU AKGÜL, Esen ŞİMŞEK, Mesut ERBAŞ, Zehra TUNÇ, Ömer Serdar AKGÜL
Journal of Experimental and Clinical Medicine - 2026;43(2):265-268
Acute ischemic stroke is an uncommon but clinically important perioperative complication. Establishing causality between anesthetic technique and stroke is often difficult because perioperative cerebrovascular events are multifactorial and may be influenced by patient-related vascular risk factors. We report a 74-year-old woman with hypertension who developed sudden dysarthria, left facial asymmetry, and left-sided weakness 20 minutes after elective flexible ureterorenoscopy performed under spinal anesthesia. Intraoperative hemodynamic parameters remained stable, and no hypoxia, bradycardia, hypotension, or loss of consciousness was observed. Emergency cranial computed tomography excluded intracranial hemorrhage, and diffusion-weighted magnetic resonance imaging demonstrated acute ischemic infarction in the right middle cerebral artery territory. Cranial computed tomography angiography did not show major intracranial arterial occlusion, while carotid imaging revealed calcified atherosclerotic plaques with mild stenosis. Intravenous alteplase was administered within the therapeutic time window after neurological evaluation. The patient showed substantial neurological improvement during follow-up and was discharged on postoperative day 6 with mild residual left lower extremity weakness. This case should be interpreted as an acute MCA infarction occurring shortly after spinal anesthesia rather than as evidence of a direct causal relationship. It highlights the importance of prompt recognition of new neurological symptoms, rapid neuroimaging, and multidisciplinary management in the early postoperative period, particularly in elderly patients with vascular risk factors.
