Contralateral Middle Cerebral Artery Territory Infarction After Anterior Cervical Diskectomy and Fusion: A Case Report.

Case: A 70-year-old man underwent anterior cervical diskectomy and fusion (ACDF) of the C3/4 and C4/5 levels by a left-sided approach to address canal stenosis causing right arm weakness. Intraoperative neuromonitoring demonstrated an intermittent decrease in left-sided motor signals. Postoperatively, the patient experienced a right middle cerebral artery stroke. At the 1-year follow-up, right arm strength had improved, but there was persistent left-sided weakness due to stroke.

Conclusion: Although rare, possible intraoperative stroke should be considered when there are changes in motor or sensory evoked potentials. In addition, considerations should be given to pursue carotid stenosis screening in patients undergoing ACDF with known atherosclerosis or stroke history.