Postoperative confusion and basilar artery stroke

Introduction: Non-focal postoperative mental status changes can be challenging. Methods: Single patient case report and medical literature review. Results: We describe a 67-year-old male who was admitted for radical cystectomy and ileal conduit urinary diversion. General anesthesia was uneventful and the patient remained hemodynamically stable throughout the procedure. At the end of the procedure, the patient's trachea was extubated. Initially, he was arousable, able to move all extremities, and answer questions appropriately. Over the next 2 hours, his mental status waxed and waned and respirations became irregular. An emergent head computed tomogram without contrast revealed a hyperdense basilar artery consistent with acute thrombosis. Vascular radiology intervention occurred approximately 9 hours after the onset of symptoms, but there was no improvement in the patient's neurological status and he subsequently died. Conclusion: Although nonfocal postoperative mental status changes are common and often secondary to benign etiologies, they may herald more significant pathology, including stroke. Patients with postoperative mental status changes should be evaluated carefully to identify life-threatening and treatable etiologies. Recent advances in the acute care of stroke, such as thrombolysis and angioplasty, can improve outcome if instituted promptly.