Case Report: Decompressive Craniectomy for COVID-19 Malignant Cerebral Artery Infarction. Is Surgery a Good Option?

Sáez-Alegre, Miguel; Feijoo, Pablo García; Millán, Pablo; Sánchez, Catalina Vivancos; Domínguez, Víctor Rodríguez; Nerin, Jorge García; Guerrero, Alberto Isla; Gandía-González, María Luisa

doi:10.3389/fneur.2021.632036

Cited by 4 publications

(4 citation statements)

References 27 publications

(17 reference statements)

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“… 12 Decompressive craniotomy with good outcome has been reported in malignant cerebral edema in association with COVID-19 strokes by Liang et al 13 in three out of seven patients and by Sáez-Alegre et al in a case of vertebral artery occlusion leading to cerebellar stroke. 14 …”

Section: Discussionmentioning

confidence: 99%

Corona, Acute Ischemic Stroke, Malignant Cerebral Edema, and Hemo-adsorption: A Case Report

Shah¹,

Shah²,

Kaidawala³

et al. 2022

Indian Journal of Critical Care Medicine

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Background COVID-19 infection can be associated with systemic hyperinflammation, hypercoagulable state, vasculitis, and cardiomyopathy leading to multiorgan failure. Use of extracorporeal blood purification has been shown to mitigate the cytokine storm, improving hemodynamic stability and pulmonary function. Case summary We report a case of a young patient with malignant cerebral edema due to acute cerebrovascular accident, with COVID-19. He was taken up for life-saving decompression craniotomy amidst the cytokine storm and multiorgan failure, and was treated with steroids, antibiotics, and Cytosorb ® therapy for the cytokine storm. IL-6 and PCT levels were reduced by 99.5 and 98.6%, respectively. Vasopressors were stopped on day 4 and successfully weaned off ventilator support by 2 weeks of tracheostomy. He was de-cannulated and discharged neurologically stable on day 32. Conclusion Timely detection of COVID-19 and anti-inflammatory and hemo-adsorption measures may be helpful in modulating cytokine storm, thereby reducing morbidity and mortality. How to cite this article Shah M, Kaidawala Z, Shah A, Desphande R. Corona, Acute Ischemic Stroke, Malignant Cerebral Edema, and Hemo-adsorption: A Case Report. Indian J Crit Care Med 2022;26(2):235–238.

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Section: Discussionmentioning

confidence: 99%

Corona, Acute Ischemic Stroke, Malignant Cerebral Edema, and Hemo-adsorption: A Case Report

Shah¹,

Shah²,

Kaidawala³

et al. 2022

Indian Journal of Critical Care Medicine

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“…Inflammatory markers were significantly elevated in all patients. The MCA was the most common artery involved and the median NIHSS was 19 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Imaging and outcomes of the included patients are summarized in Table 2.…”

Section: Current Studymentioning

confidence: 99%

“…Stroke involved anterior circulation in all except two patients. The median NIHSS score was 20 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Acute stroke management included thrombolysis in five patients and mechanical thrombectomy in nine patients.…”

Section: Systematic Searchmentioning

confidence: 99%

Effect of Decompression Craniectomy on Survival and Functional Outcome in Patients with COVID-19 and Malignant Infarct: A Retrospective Cohort Study and Review of Literature

Sudheer

Gomathy

Agarwal

et al. 2022

Journal of Stroke Medicine

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Background and objective Amongst the varied neurological manifestations of COVID-19 infection, stroke is one of the common complications. A large portion of patients had large vessel occlusion (LVO) which increases the risk of malignant cerebral infarction requiring decompressive craniectomy. The impact of COVID-19, however, on decompressive craniectomy is not well described. Through this study, we aim to study the impact of decompressive craniectomy in COVID-19 patients presented to our tertiary care hospital. Material and methods Data of all acute ischemic stroke patients who tested COVID positive during the study period was collected. From among them, patients requiring decompressive craniectomy were included. The demographic, clinico-radiological parameters related to stroke, treatment received, outcome and complications were noted. In addition, data from all case reports and case series published on patients with COVID-19, who had developed ischemic stroke and underwent decompression craniectomy was collected and systematically reviewed. Results Twenty-seven stroke patients tested positive for COVID-19 infection, out of whom five patients underwent decompression hemicraniectomy in view of neurologic deterioration. The review of literature yielded 453 abstracts. After reading the full text of 69 articles, 12 studies on 15 patients finally met our inclusion criteria and were included in the systematic review. The mortality rate was 40% among stroke patients requiring decompressive craniectomy in COVID-19 patients. The mortality rate and functional outcomes of this cohort are comparable to the pre-pandemic period. Conclusion Decompressive craniectomy is a life-saving procedure in COVID-19 patients with malignant infarctions similar to patients in the pre-COVID-19 era.

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“…Preliminary discussions have indicated limited evidence based on case reports and small case series (Bhatia et al, 2021;Chan, Salonga, & Khu, 2021;Liang et al, 2020;Sáez-Alegre et al, 2021), suggesting a suboptimal response to this surgical approach. These findings warrant further exploration of alternative strategies.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Decompressive Craniectomy in Patients with Malignant Cerebral Infarction and Co-Occurring SARS-CoV-2 Infection

Silva,

Silva

2023

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Background: Malignant ischemic stroke is a known cerebrovascular complication in patients with SARS-CoV-2 infection, and decompressive craniectomy has been proposed as a treatment option. However, there is limited data available on the outcomes of patients with malignant stroke and concurrent SARS-CoV-2 infection. This study aimed to investigate whether decompressive craniectomy is beneficial for patients with malignant stroke and SARS-CoV-2 infection. Methods: This case-control study was conducted between March 2020 and December 2021, involving patients diagnosed with malignant stroke who underwent decompressive craniectomy. A total of 52 patients were included and divided into two groups: Group 1 consisted of patients with malignant ischemic stroke and concurrent SARS-CoV-2 infection (n = 20), while Group 2 comprised patients with malignant ischemic stroke without SARS-CoV-2 infection (n = 32). Medical data were collected for analysis. Results: The data analysis included variables such as diagnosis of COVID-19 and clinical outcome of death. Statistical tests, including the Chi-squared test with Yates's correction (p = 0.9094), Fischer's Exact Test (p = 0.7708), Coefficient φ (0.0568), and Odds Ratio (1.273, 95% CI: 0.4332 -4.343), were conducted using a contingency table. The results showed no significant association between SARS-CoV-2 infection and the clinical outcome of death. Conclusion: The findings indicate that patients with SARS-CoV-2 infection benefit from decompressive craniectomy for the treatment of malignant stroke to the same extent as patients without viral infection. This study provides valuable insights into the efficacy in patients with malignant stroke and SARS-CoV-2 infection. Further research is warranted to confirm these findings and explore additional factors that may influence patient outcomes in this context.

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Case Report: Decompressive Craniectomy for COVID-19 Malignant Cerebral Artery Infarction. Is Surgery a Good Option?

Cited by 4 publications

References 27 publications

Corona, Acute Ischemic Stroke, Malignant Cerebral Edema, and Hemo-adsorption: A Case Report

Corona, Acute Ischemic Stroke, Malignant Cerebral Edema, and Hemo-adsorption: A Case Report

Effect of Decompression Craniectomy on Survival and Functional Outcome in Patients with COVID-19 and Malignant Infarct: A Retrospective Cohort Study and Review of Literature

Assessment of Decompressive Craniectomy in Patients with Malignant Cerebral Infarction and Co-Occurring SARS-CoV-2 Infection

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