Idiopathic stroke after syndromic and neuromuscular scoliosis surgery: a case report and literature review

Thomas Nguyen, Krishn Khanna, Alex L. Gornitzky, Mohammad Diab


Children with syndromic and neuromuscular scoliosis undergoing corrective surgery experience higher complication rates than those with idiopathic scoliosis. A rare but devastating complication is stroke, which occurs in 0.57% of operations for neuromuscular scoliosis but accounts for 7.6% of deaths. Comorbidities associated with non-idiopathic scoliosis that increase risk of stroke include hypercoagulability, cardiac dysfunction, and contractures, which interfere with positioning and risk vascular compromise. Syndromic and neuromuscular diseases may predispose patients to intraoperative dural tears, either primarily (e.g., dural ectasia) or secondarily, in particular due to severity of deformity. We present the case of a perioperative, idiopathic stroke in a 15-year-old boy with scoliosis in the setting of neurofibromatosis type I, reviewing possible causes as well as strategies for preoperative assessment and postoperative monitoring.