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A female patient in her mid 70s underwent aortic valve replacement and single-vessel coronary artery bypass grafting, but after awakening from anaesthesia was found to have left-sided weakness. She had a history of severe aortic stenosis, hypertension, diabetes mellitus and hyperlipidaemia. On examination, there was right gaze deviation and a dense left hemiplegia. Non-contrasted CT scan of head and cerebral angiography showed a 1.5 cm hypodense filling defect in the distal M1 segment of the right middle cerebral artery, measuring –80 Hounsfield units, consistent with fat density (figure 1A,B). There were also early ischaemic changes in the right middle cerebral artery territory. The patient …
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