Decompressive hemicraniectomy for acute ischemic stroke associated with coronavirus disease 2019 infection: Case report and systematic review

Abstract

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.

Management and Outcomes of COVID – 19 Associated Cerebral Venous Sinus Thrombosis

“…There are various considerations including the risk of worsening respiratory status, progression of multi – organ dysfunction, need for prolonged intensive care and the risk to the healthcare professionals. To – date there have been only 8 cases of DHC in COVID – 19 patients with malignant ischemic anterior circulation infarction, where 3 were discharged and mortality rates exceed 33%( 10 , 11 ). Our previous experience in DHC among patients with CVT, have proven to have excellent outcomes( 12 ).…”

Neuroimaging in COVID-19 Patients on Mechanical Ventilation Receiving Sedation: Insight Beyond Diagnosis: A Case Series

“…1 Ever since the pandemic has begun, there have been increased reports of stroke in relatively younger population, raising concern. 2 Stroke pathogenesis in COVID-19 is not entirely understood. It is difficult to ascertain whether the association is incidental or causative, and various theories have been postulated for the same.…”

“…1 Ever since the pandemic has begun, there have been increased reports of stroke in relatively younger population, raising concern. 2…”

Effect of Decompression Craniectomy on Survival and Functional Outcome in Patients with COVID-19 and Malignant Infarct: A Retrospective Cohort Study and Review of Literature

“…Inflammatory markers were significantly elevated in all patients. The MCA was the most common artery involved and the median NIHSS was 19 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). Imaging and outcomes of the included patients are summarized in Table 2.…”