A man in his mid-50s with refractory atrial fibrillation who underwent a thoracoscopic ablative procedure presented to a hospital 4 weeks later with acute-onset aphasia, right-sided hemiplegia, and a temperature of 39°C. Laboratory studies were significant for elevated white blood cell count of 9500/μL (to convert to 109 per liter, multiply by 0.001). Cerebrospinal fluid revealed white blood cell count 0 cells/μL, red blood cell count 28 cells/μL, glucose level 76 mg/dL, and protein level 48 mg/dL. Magnetic resonance imaging showed left-hemisphere watershed areas of diffusion restriction. With fever, change in mental status, and a recent cardiac procedure, there was concern for infective endocarditis and septic emboli and he was transferred to our facility.
Stanton RJ, Roesch MJ, Kanter D. Neurologic Abnormalities After Atrial Fibrillation Ablative Procedure. JAMA Neurol. 2018;75(9):1144–1145. doi:10.1001/jamaneurol.2018.1351
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