Background: Extra-cranial carotid artery disease is well known, especially in arteriopath undergoing cardiac surgery. The risk of neurological complications associated with extra cranial disease is
well known and accepted. Little is known about the isolated intra-cranial lesion in these patients.Case Report: We present the case of a 58-year-old gentleman, a chronic smoker an arteriopath, hypertensive, Abdominal Aortic Aneurysm, intermittent claudication with angina and shortness of breath. He had previous myocardial infarction with impaired LV function (EF=20%), coronary artery disease and mitral regurgitation.. Significant extra cranial carotid artery narrowing was excluded by pre-op carotid Doppler. He suffered a massive intra-cerebral haemorrhage following Mitral valve replacement and coronary grafting due to ruptured middle cerebral artery.Conclusions: Our case highlights the significance of intra cranial lesion. High-risk patients especially arteriopath should have magnetic resonance angiography pre-operatively, even in the absence of extra cranial carotid disease. Patients with critical disease may get benefit by percutaneous angioplasty. If needed, tissue valve is a better option in these patients.

Keywords: Intra cerebral Haemorrhage, cardiac surgery