Septic cerebral embolism following lumbar spine surgery in a 69-year-old man with a lumbar epidural abscess in Korea: a case report

Septic embolism and stroke are serious complications in patients with sepsis and often necessitate urgent surgical intervention to control the source of infection. A 69-year-old man presented with severe pain in his back and left thigh. Magnetic resonance imaging revealed extensive posterior epidural or subdural abscesses extending from the cervical to the lumbar level, as well as an abscess in the iliopsoas muscle. Laboratory findings indicated infection. The patient underwent urgent drainage of the abscesses and decompression of the lumbar spine. Postoperatively, he developed sudden-onset atrial fibrillation and altered mental status. Brain computed tomography showed multiple embolic infarctions. Despite treatment with aspirin, he developed intracerebral hemorrhage on the eighth postoperative day. His condition deteriorated due to persistent infection, leading to disseminated intravascular coagulation, acute kidney injury, and septic shock. The patient died on postoperative day 33. This case highlights the risk of cerebral embolism and hemorrhagic complications in patients with sepsis who undergo surgery. Early recognition of individuals at high risk and comprehensive perioperative management are critical to reducing the likelihood of such complications. Additionally, vigilant postoperative monitoring of patients with severe sepsis is necessary to improve outcomes.