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Case 34

A young lady with a stroke following insertion of a central line

This young lady presented to the Emergency Department with severe abdominal pain. She was dehydrated and hypotensive. She was thought to have small bowel obstruction due to adhesions. As part of her management a central venous catheter was inserted via the jugular vein. During this procedure she became acutely aphasic and developed a hemiplegia. This recovered over the next few days. Meanwhile her abdominal symptoms resolved, without a definite diagnosis ever being made.

The clinicians were at a loss to explain the cerebrovascular episode, but an explanation was offered by the radiologists on review of her films. The chest X-ray shown was unchanged in appearance on several occasions.