Sudden Loss of Consciousness in the Operating Room: A Case of Concomitant Stroke in a Patient With Embolic Ischemia of the Limbs.

Atrial fibrillation (AF) is associated with substantial mortality and morbidity, mainly due to thromboembolic complications such as stroke, ischemic heart disease, and arterial thromboembolic occlusion. Occasionally, these events can occur simultaneously, even in patients under long-term anticoagulation. We present a case of a 79-year-old woman with a history of AF and anticoagulation, proposed for an emergent surgical thromboembolectomy due to acute embolic ischemia of the right lower limb. Upon arrival at the operating room (OR), she was conscious and fully aware, answering the anesthesiologist's questions when, suddenly, she experienced a loss of consciousness with apnea and a Glasgow Coma Scale (GCS) of 3. A head and neck computed tomography angiography (CTA) showed no acute lesions and no evidence of occlusion of the main intracranial and neck vessels. During transport to the radiology department, the patient began to slowly regain consciousness, and after the examination, she was, again, conscious and cooperative, without evident neurological deficits. After discussion with the stroke unit team, the most probable diagnosis was a vertebrobasilar territory transient ischemic attack (TIA) with quick spontaneous reperfusion. Vertebrobasilar territory ischemic events have a wide variety of presentations, with some patients presenting with coma. A concomitant ischemic stroke in a patient with an arterial thromboembolic occlusion is a rarely reported event, with potential for serious morbidity and mortality if not promptly managed. This case highlights the importance of being alert for these concomitant events, at any time, in the care of patients with other thromboembolic complications. Clinicians should maintain a high level of suspicion because the swift identification and treatment of stroke are essential to improve outcomes.