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Intracranial Pressure Dynamics and Cerebral Vasomotor Reactivity in Coronavirus Disease 2019 Patient With Acute
Teodor Svedung Wettervik1, Eva Kumlien2, Elham Rostami1
1Department of Neuroscience, Section of Neurosurgery, Uppsala University, Uppsala, Sweden.
Insights
This case report details intracranial pressure monitoring in a patient with COVID-19-induced encephalitis. Intracranial pressure monitoring revealed high plateau waves, necessitating cerebrospinal fluid drainage and therapeutic plasma exchange for improved outcomes.
Area of Science:
- Neurology
- Intensive Care Medicine
- Infectious Diseases
Background:
- Coronavirus disease 2019 (COVID-19) can cause severe neurological complications, including acute encephalitis.
- Intracranial hypertension is a critical concern in severe COVID-19 neurological cases.
- Cerebrospinal fluid drainage and therapeutic plasma exchange are potential treatment modalities.
Observation:
- A case report of a COVID-19 patient with acute encephalitis.
- Intracranial pressure monitoring revealed frequent plateau waves (>40 mm Hg) and low intracranial compliance.
- Cerebral vasomotor reactivity was intact, indicating preserved pressure autoregulation.
Findings:
- Intracranial pressure monitoring is valuable in selected COVID-19 patients with suspected increased intracranial pressure.
- Low intracranial compliance and intact pressure reactivity contributed to intracranial pressure variability.
- Therapeutic plasma exchange was safe and effective, reducing neuroinflammation and improving consciousness.
Implications:
- Intracranial pressure monitoring may guide management in severe COVID-19 encephalitis.
- Understanding intracranial pressure dynamics is crucial for optimizing treatment strategies.
- Early detection and intervention for intracranial hypertension can improve patient outcomes in COVID-19 neurological complications.
Abstract:
We describe the intracranial pressure dynamics and cerebral vasomotor reactivity in a coronavirus disease 2019 patient with acute encephalitis treated with cerebrospinal fluid drainage and therapeutic plasma exchange.
Data Sources:
Coronavirus disease ICU, Uppsala University Hospital, Sweden.
Study Selection:
Case report.
Data Extraction:
Radiology, intracranial pressure, intracranial compliance (correlation between intracranial pressure amplitude and mean intracranial pressure), cerebral vasomotor reactivity (pressure reactivity index), arterial blood pressure, cerebrospinal fluid chemistry, and treatment.
Data Synthesis:
None.
Conclusions:
This is the first reported case of intracranial pressure monitoring in a patient with acute encephalitis following coronavirus disease 2019. Intracranial pressure data exhibited a high incidence of plateau waves with intracranial pressure insults above 40 mm Hg that required cerebrospinal fluid drainage. Intracranial compliance was low, and pressure reactivity was intact. It is probable that the combination of low intracranial compliance and intact pressure autoregulation explain the high degree of plateau intracranial pressure waves and intracranial pressure variability. This case illustrates that it could be of value to consider intracranial pressure monitoring in selected coronavirus disease 2019 patients with suspicion of increased intracranial pressure to be able to confirm and treat intracranial hypertension if needed. In this patient, therapeutic plasma exchange was safe and efficacious as the level of neuroinflammation decreased and the patient regained consciousness.
