Arnaud Baldivia: Peri-Procedural Stroke – An Underestimated Emergency in the Operating Room and in the ICU
Arnaud Baldivia, Founder of Vox Medica, shared a post on LinkedIn:
“Peri-procedural stroke: an underestimated emergency in the operating room and in the ICU
A sudden neurological deficit in the perioperative setting is never trivial.
And above all: it’s not up to us to guess — it’s up to the imagery to decide.
The 2026 RFE GIHP/SFAR finally clarify the course of action to be taken.
The key reflex
Any neuro deficit is equal to stroke until proven otherwise
- Unexplained delay in waking up
- Hemiparesis/facial asymmetry
- Aphasia, impaired consciousness
- Gaze Deviation
Immediate care
- Supine position
- Emergency brain imaging (parenchyma + vessels)
- Call for neurovascular team
- NO antithrombotics before imaging
Blood pressure: Hypertension is respected up to 220/120 mmHg
The antihypertensive reflex in the ICU can be deleterious
No benefit demonstrated in lowering BP in the acute phase
What really changes in 2026
- Reperfusion possible up to 24 hours
- Early resumption of DOACs validated:
Minor stroke – 48 hours
Moderate/severe stroke – no more than day 4
End of the dogma ‘wait 7–14 days’
The real issue
Delicate balance between:
- Cerebral ischaemic risk
- Post-operative bleeding risk
Decision still individualized, but framework finally clarified
4 reflexes to remember
- Sudden deficit is equal imaging plus immediate neurovascular
- Zero antithrombotics before CT/MRI
- Wide Blood Pressure Tolerance (≤ 220/120)
- Early DOAC recovery according to severity
In practice:
This is not an uncommon complication… it is a complication that is not well recognized.
And in this context, every minute counts as much as in pre-hospital ‘Time is Brain’.”
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