Perioperative management of acute ischemic stroke: a case report

Interrupting anticoagulation in patients at high risk for thromboembolism, even for critically important surgery, may lead to devastating outcomes. The patient described developed "Locked-in Syndrome" from basilar arterial thrombosis within 24 hours of withholding anticoagulation for urgent airway surgery. Emergency thrombolysis partially restored arterial flow, with recovery of some function. The dangers of hemorrhage during surgery must be balanced against the potentially devastating consequences of withholding anticoagulation in patients at high risk for thrombosis.