• J-Y Bien, J Morel, S Demasles, K Abboud, and S Molliex.
• 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.
• Ann Fr Anesth Reanim. 2014 Dec 1;33(12):696-9.

AbstractThe 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.Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

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