Post-operative ischaemic stroke after transpulmonary embolism: A diagnostic challenge

Abstract

Fixing a femoral neck fracture in elderly patients restores their independent mobility, and decreases the associated mortality and morbidity. Perioperative stroke is the most undesired complication in such patients, having a miserable outcome. We report a similar case where the patient developed ischaemic stroke in the immediate post-operative period, where a diagnostic workup revealed the presence of a new-onset pulmonary arterial hypertension with suspected embolism, in the absence of cardiopulmonary shunt, visible thrombus or embolus of cardiac origin. This case highlights the diagnostic dilemma in evaluating the cause of post-operative stroke and emphasises the need for a multimodal approach to investigate the suspected acute pulmonary embolism and to identify the possible sites for the origin of an embolus.

Keywords

• angiography
• deep-vein thrombosis
• ischaemic stroke
• pulmonary embolism