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Cesarean Hysterectomy in a Parturient With Morbidly Adherent Placenta Complicated by Postoperative Ischemic Stroke Secondary to Vertebral Artery Dissection

A Case Report

Feldman, Joshua Bradley, DO; Kumaraswami, Sangeeta, MD

doi: 10.1213/XAA.0000000000000829
Case Reports

We report a case of cesarean hysterectomy in a parturient with morbidly adherent placenta that was complicated by an estimated blood loss of 25 L, with the usage of massive transfusion protocols. On the third postoperative day, symptomatology suggestive of a stroke was elicited. Imaging showed a right vertebral artery dissection with cerebellar, midbrain, and pontine infarcts. She showed gradual recovery in the following months with almost complete return to baseline function. We present this case to highlight vertebral artery dissection as a potential complication after peripartum massive blood transfusion and to consider the management decisions this scenario presents.

From the Department of Anesthesiology, New York Medical College at Westchester Medical Center, Valhalla, New York.

Accepted for publication May 21, 2018.

Funding: None.

The authors declare no conflicts of interest.

This case report was presented as poster MC3119, “Vertebral artery Dissection in a Case of Placenta Percreta involving Massive Transfusion” at a Medically Challenging Case session at the 2017 American Society of Anesthesiologists meeting, Boston, MA.

Address correspondence to Sangeeta Kumaraswami, MD, Department of Anesthesiology, Westchester Medical Center, 100, Woods Rd, Macy Pavilion 2391, Valhalla, NY 10595. Address e-mail to

© 2019 International Anesthesia Research Society
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