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Ipsilateral parenchymal hemorrhage after hemicraniectomy in a patient suffering from malignant middle cerebral artery

Claudia Disqué1, Georg Gahn

  • 1Technical University Dresden, Neurology Department, Dresden, Germany. claudiadisque@web.de

The Neurologist
|March 14, 2007
PubMed
Abstract

Insights

Early hemicraniectomy for malignant middle cerebral artery infarction can lead to deep hemorrhage, a rare complication. This case highlights hemorrhagic transformation as a potential risk factor following the procedure.

Area of Science:

  • Neurosurgery
  • Neurology
  • Critical Care Medicine

Background:

  • Malignant middle cerebral artery (MCA) infarction carries high mortality.
  • Early hemicraniectomy significantly reduces mortality but functional outcomes remain debated.
  • Hemorrhagic complications, such as epidural or subgaleal hematomas, are known risks of hemicraniectomy.

Observation:

  • A 55-year-old male presented with severe stroke symptoms (NIHSS 18, GCS 3) due to left MCA occlusion.
  • Despite rtPA and early hemicraniectomy, the patient developed deep intracerebral hemorrhage and obstructive hydrocephalus.
  • An extraventricular drainage (EVD) was placed to manage intracranial pressure.

Findings:

  • This case represents the first reported instance of deep hemorrhage post-hemicraniectomy in the literature.
  • Hemorrhagic transformation of the infarct is identified as a potential risk factor for significant hemorrhage after hemicraniectomy.
  • The patient's neurological status remained severe (NIHSS 18, GCS 10) at discharge.

Implications:

  • The findings suggest a need for vigilant monitoring for hemorrhagic complications after hemicraniectomy, especially in cases with hemorrhagic transformation.
  • Further research is warranted to elucidate the mechanisms and risk factors for deep hemorrhage following this life-saving procedure.
  • This case underscores the complex risk-benefit profile of hemicraniectomy in malignant MCA infarction.

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