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JAMA Neurology Clinical Challenge
September 2018

Neurologic Abnormalities After Atrial Fibrillation Ablative Procedure

Author Affiliations
  • 1Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
  • 2Department of Pathology, University of Cincinnati College of Medicine, Cincinnati, Ohio
JAMA Neurol. 2018;75(9):1144-1145. doi:10.1001/jamaneurol.2018.1351

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.