Fatal ischemia stroke in a patient with an asymptomatic carotid artery occlusion after lumbar spine surgery - A case report

Recognizing carotid stenosis (CAS) in an asymptomatic patient preoperatively is difficult. We report a 63-year-old female who had diabetes mellitus and hypertension suffered from a fatal ischemic stroke secondary to a total occlusion of the left carotid artery after a lumbar spine surgery in the prone position. Intraoperative induced hypotension and neck rotation in this patient should be considered as contributory factors. According to previous studies extensively screening out CAS is not recommended. Using electroencephalography (EEG) or somatosensory evoked potential (SSEP) to monitor brain function and carefully positioning of the neck are recommended in these patients who are at risk of stroke while receiving induced hypotension during lumbar spine surgery in the prone position.