Ischemic stroke following corrective surgery for idiopathic scoliosis in a pediatric patient: the importance of early diagnosis.

Abstract

To present a rare case of a cerebral ischemic lesion of unknown etiology in a pediatric patient following idiopathic scoliosis surgery and to review the current literature regarding this complication in children. A 12-year-old female with early-onset scoliosis underwent surgery to correct a 65.6º scoliosis after a normal preoperative study. T4-L1 posterior instrumentation was performed uneventfully. Twelve hours postoperatively, she developed central left facial paresis, diplopia, and gait instability. An urgent MRI scan revealed an acute ischemic lesion in the right parasagittal subthalamic-mesencephalic region, for which she received anticoagulant therapy with close monitoring. The diagnosis of "stroke of undetermined etiology" was made according to the CASCADE (Childhood Arterial Ischemic Stroke Standardized Classification and Diagnostic Evaluation) criteria. Therefore, prophylaxis was changed to antiplatelet therapy for 3 months. Symptoms resolved within a week, except for an occasional diplopia that subsided after 2 months, being asymptomatic at 2 years of follow-up. Although a rather frequent complication in adults, there are only 2 other reported cases of ischemic stroke in pediatric patients after scoliosis surgery, both related to longer procedures and underlying disease. Even so, it is important to consider this potential perioperative spinal complication due to the importance of early diagnosis and adequate acute treatment for prognosis.