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Decompressive hemicraniectomy for acute ischemic stroke associated with coronavirus disease 2019 infection: Case
Kevin Ivan Peñaverde Chan1, Alaric Emmanuel Mendoza Salonga1, Kathleen Joy Ong Khu1
1Department of Neuroscience, Philippine General Hospital, Manila, National Capital Region, Philippines.
Insights
Decompressive hemicraniectomy for acute ischemic stroke in COVID-19 patients is rarely reported, with poor outcomes. Respiratory failure was the most common cause of death in these cases.
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Limited data exists on decompressive hemicraniectomy (DH) for acute ischemic stroke in COVID-19 patients.
- Neurovascular complications are a concern in coronavirus disease 2019 (COVID-19) infection.
Observation:
- A case of a 36-year-old woman with COVID-19 who developed an internal carotid artery infarct and underwent DH is presented.
- A systematic review identified eight additional cases of DH for ischemic stroke in COVID-19 patients.
- Patients were predominantly female (2:1), with a mean age of 48, and respiratory symptoms preceding neurological ones in 83%.
Findings:
- The internal carotid artery was the most commonly affected vessel.
- Decompressive hemicraniectomy was performed at a mean of 1.8 days post-ictus.
- Only four of nine patients survived, with respiratory failure being the primary cause of mortality (60%).
Implications:
- Clinicians must be aware of potential neurovascular complications in COVID-19 patients.
- Outcomes for DH in COVID-19 associated stroke are generally poor, even with early surgical intervention.
Background:
Decompressive hemicraniectomy (DH) has been performed for some cases of acute ischemic stroke in patients with coronavirus disease 2019 (COVID-19) infection, but there is little information about the clinical course and outcomes of these patients.
Case Description:
We report a case of a 36-year-old woman with COVID-19 infection who developed stroke like symptoms while under home quarantine. Cranial CT scan showed an acute left internal carotid artery (ICA) infarct. She subsequently underwent an emergent left DH. Despite timely surgical intervention, she succumbed to chronic respiratory failure. A systematic review of SCOPUS and PubMed databases for case reports and case series of patients with COVID-19 infection who similarly underwent a DH for an acute ischemic infarct was performed. There were eight other reported cases in the literature. The patients' age ranged from 33 to 70 years (mean 48), with a female predilection (2:1). Respiratory preceded neurologic symptoms in 83% of cases. The ICA was the one most commonly involved in the stroke, and the mean NIHSS score was 20. DH was performed at a mean of 1.8 days post-ictus. Only four out of the nine patients were reported alive at the time of writing. The most common cause of death was respiratory failure (60%).
Conclusion:
Clinicians have to be cognizant of the neurovascular complications that may occur during the course of a patient with COVID-19. DH for acute ischemic stroke associated with the said infection was reported in nine patients, but the outcomes were generally poor despite early surgical intervention.
