Bilateral occipital ischaemic stroke due to sepsis

Presentation 

A 48-year-old female presented with LIF pain. CT Abdomen/Pelvis revealed sigmoid diverticulitis with pericolonic abscess (Hinchey 1B). 

Diagnosis 

X became peritonitic while awaiting percutaneous abscess drainage. An emergency Hartmann’s procedure was therefore performed. She bilateral visual loss post-extubation which was attributed to bilateral occipital infarcts seen on MRI Brain. TOE, telemetry, CT Angiogram Intracranial/Carotids, and a Haematology blood panel revealed no aetiological source. The cause of X’s stroke was concluded to be a combination of sepsis-related cerebral hypoperfusion and hypercoagulability. 

Treatment 

She was given Aspirin 300mg daily for two weeks and discharged on Aspirin 75mg od for life. 

Discussion 

This case underscores the association between infection and ischaemic stroke, even without an underlying cardiac, vascular, or haematological cause. It emphasises the importance of rapid and effective source control in patients with infection to prevent sepsis and associated sequelae. This includes stroke, which can precipitate significant and permanent functional deficits in otherwise young and healthy patients.