Posterior Cerebral Infarction following Loss of Guide Wire

Stroke after internal jugular venous cannulation typically leads to acute carotid or vertebral arteries injury and cerebral ischemia. We report the first case of delayed posterior cerebral infarction following loss of guide wire after left internal jugular venous cannulation in a 46-year-old woman with a history of inflammatory bowel disease. Our observation highlights that loss of an intravascular guide wire can be a cause of ischemic stroke in patients undergoing central venous catheterization. 1. Introduction Inadequate placement of a jugular venous catheter is a well-known complication, with serious and immediate secondary complications including stroke. Acute complications are usually associated with injury to contiguous structures [1], leading to carotid [2–6] or vertebral [7–9] arteries thrombosis and cerebral ischemia [2–4]. Here we present the first case of delayed posterior cerebral infarction following loss of guide wire after left internal jugular venous cannulation. 2. Case Presentation A 46-year-old woman with a history of inflammatory bowel disease was admitted for recurrence of severe active colitis and treated by intravenous corticosteroids. Left internal jugular venous cannulation was performed for total parenteral nutrition using the Seldinger technique. During catheterization, the patient suddenly experienced transient dizziness and blurred vision. No further problems were observed after withdrawing the catheter. The anaesthetist did not report any inattention during the procedure. Five days after hospital discharge, the patient presented sudden onset of difficult swallowing. Neurological examination revealed left hemiataxia with hypermetria, left Horner’s sign, right deviation of the uvula indicating left palatal palsy, and hypoesthesia of the left hemiface. General examination revealed left cervical subcutaneous hematoma with no hemodynamic impairment (Figure 1(a)). Brain magnetic resonance imaging showed multiple acute cerebral infarcts in the vertebrobasilar territory (Figures 1(b) and 1(c)) and magnetic resonance angiography showed left vertebral artery occlusion from its origin (segment ) to segment with no signs of arterial dissection (Figure 1(d)). A lost guide wire was suspected on chest radiography (Figure 2(a)). Cervical CT angiography showed that the guide wire had been inadvertently inserted into the left subclavian artery, causing left vertebral artery occlusion. The upper extremity of the guide wire was located in the extravascular cervical region (Figure 2(b)), and total body CT scan showed the intravascular course of