COVID-19 and Decompressive Hemicraniectomy for Acute Ischemic Stroke

Liang, John; Reynolds, Alexandra S.; Reilly, Kaitlin; Lay, Cappi; Kellner, Christopher P.; Shigematsu, Tomoyoshi; Gilligan, Jeffrey; Majidi, Shahram; Al‐Mufti, Fawaz; Bederson, Joshua B.; Mocco, J; Dhamoon, Mandip S.; Dangayach, Neha

doi:10.1161/strokeaha.120.030804

Cited by 22 publications

(19 citation statements)

References 4 publications

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“…The remaining 19 studies were conducted as retrospective studies reporting on neuroimaging findings of AIS patients. 12,18,[21][22][23][24][56][57][58][59][60][61][62][63][64][65][66] Sample sizes ranged from 1 to 116 patients. The median of reported mean age was 64.5 years (interquartile range [IQR] = 56-72 years; range = 43.5-81 years).…”

Section: Cerebrovascular Diseases Ischemic Strokementioning

confidence: 99%

COVID‐19: Neuroimaging Features of a Pandemic

Ladopoulos

Zand

Shahjouei

et al. 2021

Journal of Neuroimaging

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The ongoing Coronavirus Disease 2019 (COVID-19) pandemic is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 is occasionally associated with manifold diseases of the central nervous system (CNS). We sought to present the neuroimaging features of such CNS involvement. In addition, we sought to identify typical neuroimaging patterns that could indicate possible COVID-19-associated neurological manifestations. METHODS: In this systematic literature review, typical neuroimaging features of cerebrovascular diseases and inflammatory processes associated with COVID-19 were analyzed. Reports presenting individual patient data were included in further quantitative analysis with descriptive statistics. RESULTS: We identified 115 studies reporting a total of 954 COVID-19 patients with associated neurological manifestations and neuroimaging alterations. A total of 95 (82.6%) of the identified studies were single case reports or case series, whereas 660 (69.2%) of the reported cases included individual information and were thus included in descriptive statistical analysis. Ischemia with neuroimaging patterns of large vessel occlusion event was revealed in 59.9% of ischemic stroke patients, whereas 69.2% of patients with intracerebral hemorrhage exhibited bleeding in a location that was not associated with hypertension. Callosal and/or juxtacortical location was identified in 58.7% of cerebral microbleed positive images. Features of hemorrhagic necrotizing encephalitis were detected in 28.8% of patients with meningo-/encephalitis. CONCLUSIONS: Manifold CNS involvement is increasingly reported in COVID-19 patients. Typical and atypical neuroimaging features have been observed in some disease entities, so that familiarity with these imaging patterns appears reasonable and may assist clinicians in the differential diagnosis of COVID-19 CNS manifestations.

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Section: Cerebrovascular Diseases Ischemic Strokementioning

confidence: 99%

COVID‐19: Neuroimaging Features of a Pandemic

Ladopoulos

Zand

Shahjouei

et al. 2021

Journal of Neuroimaging

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“…Although it has been described as reducing mortality and morbidity ( 18 – 23 ) sometimes the baseline situation of the patient, the presence of antiaggregant and anticoagulant drugs, or severe sequelae, makes it difficult to take this decision. Another special situation is the involvement of the dominant hemisphere in the infarction.…”

Section: Discussionmentioning

confidence: 99%

“…In our case, surgery was performed 9 h after deterioration and there were no complications associated with COVID-19. Liang et al ( 18 ) described three cases, one of them underwent surgery on day 2 post-stroke and died due to concomitant ST-segment–elevation myocardial infarction. Roy et al ( 19 ) described a case who received surgical treatment 9 h after the stroke, unfortunately, the patient developed refractory hypoxemia in the postoperative period due to extensive pulmonary embolus and died.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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SARS-CoV2 infection can lead to a prothrombotic state. Large vessel occlusion, as well as malignant cerebral stroke have been described in COVID-19 patients. In the following months, given the increase in COVID-19 cases, an increase in malignant cerebral SARS-CoV2 associated strokes are expected. The baseline situation of the patients as well as the risk of evolution to a serious disease due to the virus, depict a unique scenario. Decompressive craniectomy is a life-saving procedure indicated in patients who suffer a malignant cerebral stroke; however, it is unclear whether the same eligibility criteria should be used for patients with COVID-19. To our knowledge seven cases of decompressive craniectomy and malignant cerebral stroke have been described to date. We report on a 39-year-old female with no major risk factors for cerebrovascular disease, apart from oral contraception, and mild COVID-19 symptoms who suffered from left hemispheric syndrome. The patient underwent endovascular treatment with stenting and afterward decompressive craniectomy due to a worsening neurological status with unilateral unreactive mydriasis. We present the case and provide a comprehensive review of the available literature related to the surgical treatment for COVID-19 associated malignant strokes, to establish whether the same eligibility criteria for non-COVID-19 associated strokes should be used. Eight patients, including our case, were surgically managed due to malignant cerebral stroke. Seven of these patients received decompressive craniectomy, and six of them met the eligibility criteria of the current stroke guidelines. The mortality rate was 33%, similar to that described in non-COVID-19 cases. Two patients had a left middle cerebral artery (MCA) and both survived after decompressive craniectomy. Our results support that decompressive craniectomy, using the current stroke guidelines, should be considered an effective life-saving treatment for COVID-19-related malignant cerebral strokes.

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“…Currently, several reports have proved that SARS-Cov-2 affects cerebral neurons resulting in insomnia, headache, stroke, mild cognitive impairment, epilepsy and encephalorrhagia [11,12]. As we all know that severe acute respiratory syndrome coronavirus (SARS) in uences nervous system and induces polyneuropathy, encephalitis, ischemic stroke [13,14]. SARS-Cov-2 shares 79.5% genetic similarity to SARS and main infection sites are lung [1].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Associated Cerebral Infarction in an Elderly Patient: A Case Report

Xie

Feng

Wang

et al. 2021

Preprint

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Background: The 2019 Severe Acute Respiratory Syndrome Coronavirus (SARS-Cov-2) had been declared an emergency at the beginning and eventually progressing to a pandemic by World Health Organization. To date, more than 78,194,9471 people confirmed infected by SARS-Cov-2 and 1,736,752 dead, globally. Various characteristics were described in the case reports and clinical studies after SARS-Cov-2 hitting the whole world. Case presentation：COVID-19 cases accompanied with cerebral infraction were hardly reported. Herein, we present a 74-yesrs-old patient who got SARS-Cov-2 infected at the late January and developed cerebral infraction. After accurate treatment, the old patient recovered and discharged from hospital on April 3, 2020. We keep on supervising the patient, after 7 months long physical condition surveillance, the patient live a normal life with on obvious sequelae detected. Conclusions: In this paper, we present a elder COVID-19 case associated with cerebral infraction and whole process management in treatment. The elder patients lived a normal life after discharging from Huangshi central hospital which we believed that early introducing of traditional Chinese medicine played important roles in COVID-19 treatment. We aimed to broaden new cognition towards SARS-Cov-2 infection and suggest therapy to COVID-19 cases with cerebral infraction.

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COVID-19 and Decompressive Hemicraniectomy for Acute Ischemic Stroke

Cited by 22 publications

References 4 publications

COVID‐19: Neuroimaging Features of a Pandemic

COVID‐19: Neuroimaging Features of a Pandemic

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

COVID-19 Associated Cerebral Infarction in an Elderly Patient: A Case Report

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