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Corona, Acute Ischemic Stroke, Malignant Cerebral Edema, and Hemo-adsorption: A Case Report
Mehul Shah1, Zakaria Kaidawala1, Arun Shah2
1Department of Critical Care Medicine, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India.
Insights
This case report highlights how extracorporeal blood purification, alongside standard treatments, helped manage a severe COVID-19 case complicated by a stroke. Early intervention with Cytosorb therapy reduced critical inflammatory markers, aiding patient recovery.
Area of Science:
- Critical Care Medicine
- Neurology
- Infectious Diseases
Background:
- COVID-19 is linked to severe systemic inflammation, coagulopathy, and organ failure.
- Extracorporeal blood purification can mitigate the cytokine storm in critical illness.
- Cytokine storm contributes to poor outcomes in severe COVID-19.
Observation:
- A young patient with COVID-19 developed malignant cerebral edema secondary to acute ischemic stroke.
- The patient underwent emergency decompression craniotomy during a cytokine storm and multiorgan failure.
- Treatment included steroids, antibiotics, and Cytosorb therapy for cytokine removal.
Findings:
- Cytosorb therapy significantly reduced Interleukin-6 (IL-6) and procalcitonin (PCT) levels by 99.5% and 98.6%, respectively.
- Hemodynamic stability improved, allowing vasopressor discontinuation on day 4.
- The patient was successfully weaned from mechanical ventilation and discharged neurologically stable.
Implications:
- This case suggests that prompt diagnosis of COVID-19 and combined anti-inflammatory and hemoadsorption strategies can modulate the cytokine storm.
- Such interventions may reduce morbidity and mortality in critically ill COVID-19 patients with neurological complications.
- Hemo-adsorption offers a potential adjunctive therapy for managing severe COVID-19-associated hyperinflammation.
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.
