{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:28:17Z","timestamp":1787228897970,"version":"build-2736575974"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Postoperative stroke after noncardiac, non-neurologic surgery is rare but can lead to devastating outcomes. Although venous thromboembolism is a well-known complication after total knee arthroplasty (TKA), arterial thrombosis, particularly involving large cerebral vessels, is exceedingly uncommon. A 72-year-old woman with hypertension, diabetes mellitus, and hyperlipidemia underwent left TKA under general anesthesia. On postoperative day (POD) 2, she developed acute mental change and right-sided weakness temporally coinciding with transfusion of leukocyte-depleted red blood cells. Brain computed tomography angiography revealed left middle cerebral artery (MCA) occlusion. Mechanical embolectomy successfully retrieved a red thrombus and recanalized the occluded vessel, and the patient gradually recovered, being transferred for rehabilitation on POD 28. This case demonstrates that acute cerebral artery thrombosis can occur even in the absence of cardiac embolic sources after TKA. The early detection of the symptoms related to stroke and prompt evaluation for large-vessel occlusion are essential for the reduction of mortality.<\/jats:p>","DOI":"10.4103\/sja.sja_66_26","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T05:00:53Z","timestamp":1782968453000},"page":"706-709","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Acute middle cerebral artery thrombosis in the early postoperative period after total knee arthroplasty under general anesthesia: A case report"],"prefix":"10.4103","volume":"20","author":[{"given":"Kwanghyuk","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-Do, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang Il","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-Do, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-Do, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min Hee","family":"Heo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Inje University Ilsan Paik Hospital, Goyang, Gyeonggi-Do, South Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"R1-20260820","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1007\/s12630-015-0494-9","article-title":"Perioperative stroke","volume":"63","author":"Vlisides","year":"2016","journal-title":"Can J Anaesth"},{"key":"R2-20260820","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4097\/kjae.2018.71.1.3","article-title":"Perioperative stroke: Pathophysiology and management","volume":"71","author":"Ko","year":"2018","journal-title":"Korean J Anesthesiol"},{"key":"R3-20260820","doi-asserted-by":"crossref","first-page":"e0239239","DOI":"10.1371\/journal.pone.0239239","article-title":"Incidence, predictors, and timing of post-operative stroke following elective total hip arthroplasty and total knee arthroplasty","volume":"15","author":"Haynes","year":"2020","journal-title":"PLoS One"},{"key":"R4-20260820","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jclinepi.2013.08.003","article-title":"The CARE guidelines: Consensus-based clinical case report guideline development","volume":"67","author":"Gagnier","year":"2014","journal-title":"J Clin Epidemiol"},{"key":"R5-20260820","doi-asserted-by":"crossref","first-page":"e0051","DOI":"10.2106\/JBJS.RVW.19.00051","article-title":"Vascular injuries in total knee arthroplasty: A systematic review and meta-analysis","volume":"8","author":"Sundaram","year":"2020","journal-title":"JBJS Rev"},{"key":"R6-20260820","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1016\/j.bja.2022.06.036","article-title":"Patent foramen ovale and perioperative stroke in noncardiac surgery: A systematic review and meta-analysis","volume":"129","author":"Rais","year":"2022","journal-title":"Br J Anaesth"},{"key":"R7-20260820","doi-asserted-by":"crossref","first-page":"443","DOI":"10.4070\/kcj.2009.39.11.443","article-title":"Cardioembolic stroke in atrial fibrillation-rationale for preventive closure of the left atrial appendage","volume":"39","author":"Leith\u00e4user","year":"2009","journal-title":"Korean Circ J"},{"key":"R8-20260820","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1046\/j.1365-2044.2001.01982.x","article-title":"The arterial tourniquet: Pathophysiological consequences and anaesthetic implications","volume":"56","author":"Kam","year":"2001","journal-title":"Anaesthesia"},{"key":"R9-20260820","doi-asserted-by":"crossref","first-page":"826","DOI":"10.1001\/jamasurg.2018.1565","article-title":"Association of perioperative red blood cell transfusions with venous thromboembolism in a North American registry","volume":"153","author":"Goel","year":"2018","journal-title":"JAMA Surg"},{"key":"R10-20260820","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1186\/s43019-021-00099-y","article-title":"Asia-Pacific venous thromboembolism consensus in knee and hip arthroplasty and hip fracture surgery: Part 1. Diagnosis and risk factors","volume":"33","author":"Ngarmukos","year":"2021","journal-title":"Knee Surg Relat Res"}],"container-title":["Saudi Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.sja_66_26","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:01:31Z","timestamp":1787227291000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/sja.sja_66_26"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":10,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/sja.sja_66_26","relation":{},"ISSN":["1658-354X","0975-3125"],"issn-type":[{"value":"1658-354X","type":"print"},{"value":"0975-3125","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2026-01-25","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-27","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}