Acute middle cerebral artery thrombosis in the early postoperative period after total knee arthroplasty under general anesthesia: A case report

ABSTRACT Postoperative stroke after noncardiac, non-neurologic surgery is rare but can lead to devastating outcomes. Although venous thromboembolism is a well-known complication after total knee arthroplasty (TKA), arterial thrombosis, particularly involving large cerebral vessels, is exceedingly uncommon. A 72-year-old woman with hypertension, diabetes mellitus, and hyperlipidemia underwent left TKA under general anesthesia. On postoperative day (POD) 2, she developed acute mental change and right-sided weakness temporally coinciding with transfusion of leukocyte-depleted red blood cells. Brain computed tomography angiography revealed left middle cerebral artery (MCA) occlusion. Mechanical embolectomy successfully retrieved a red thrombus and recanalized the occluded vessel, and the patient gradually recovered, being transferred for rehabilitation on POD 28. This case demonstrates that acute cerebral artery thrombosis can occur even in the absence of cardiac embolic sources after TKA. The early detection of the symptoms related to stroke and prompt evaluation for large-vessel occlusion are essential for the reduction of mortality.