A 46-year-old female was scheduled for neck lymph node dissection. The patient suffered from quadriplegia and aphasia after the surgery. Acute cervical spine injury with acute ischemic stroke was indicated by MRI images. Neck extension and hypotensive episodes may together have contributed to the neurologic insult. Assessment of limitation of neck mobility and image examination should be performed at the preoperative stage. Early diagnosis and treatment of neurologic insult may not only improve patient recovery, but may also prevent further deterioration.