Teaching NeuroImages: Cerebral liposuction

A 61-year-old woman showed left hemiplegia and neglect while recovering 6 hours after aortic valve repair. CT showed a hypodense middle cerebral artery segment. CT angiography and CT perfusion (CTP) revealed a carotid terminus occlusion and a large penumbra around a small ischemic core. This prompted cerebral angiography, and embolectomy by Sofia catheter aspiration removed a 1.5-cm piece of adipose tissue, presumably pericardial fat introduced during aortotomy (figure). The neglect, hemianopia, and hemiparesis improved thereafter. This demonstrates a successful fat embolus aspiration to treat stroke after cardiac surgery, and which should be considered if deficits are recognized early and CTP shows significant salvageable tissue.1,2