Cerebellar infarction requiring surgical decompression in patient with COVID 19 pathological analysis and brief review

Interdisciplinary Neurosurgery

Jeffrey S. Lobel¹  Asma Syed²  Hiren N. Patel³  Micheal Puumala⁴  Robert Galler⁵  Joseph Georges⁶  Margaret Carmody⁷ 

[1] Corresponding author at: Department of Neurosurgery, Avera McKennan Hospital, 1301 S Cliff Ave Ste 610, Sioux Falls, SD 57105, United States.;Newton-Wellesley Hospital, Department of Neurosurgery, 2014 Washington St, Newton, MA, USA;Avera McKennan Hospital, Department of Neurosurgery, USA;Cooper University Hospital, Department Neurosurgery, 1 Cooper Plaza, Camden, NJ, USA;Infectious Disease, 1301 S Cliff Ave Ste 610, Sioux Falls, SD, USA;Lima Memorial Hospital, Department of Neurosurgery, 1001 Bellefontaine Ave, Lima, OH, USA;Northwell Health, Department of Neurosurgery, 1300 Roanoke Ave, Riverhead, NY 11901, USA;

关键词: Coronavirus;    COVID-19;    SARS-COV-2;    Ischemic stroke;    Sub-occipital craniectomy;    Vasculitis;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background: This report and literature review describes a case of a COVID-19 patient who suffered a cerebellar stroke requiring neurosurgical decompression. This is the first reported case of a sub-occipital craniectomy with brain biopsy in a COVID-19 patient showing leptomeningeal venous intimal inflammation. Clinical description: The patient is a 48-year-old SARS-COV-2 positive male with multiple comorbidities, who presented with fevers and respiratory symptoms, and imaging consistent with multifocal pneumonia. On day 5 of admission, the patient had sudden change in mental status, increased C-Reactive Protein, ferritin and elevated Interleukin-6 levels. Head CT showed cerebral infarction from vertebral artery occlusion. Given subsequent rapid neurologic decline from cerebellar swelling and mass effect on his brainstem emergent neurosurgical intervention was performed. Brain biopsy found a vein with small organizing thrombus adjacent to focally proliferative intima with focal intimal neutrophils. Conclusion: A young man with COVID-19 and suspected immune dysregulation, complicated by a large cerebrovascular ischemic stroke secondary to vertebral artery thrombosis requiring emergent neurosurgical intervention for decompression with improved neurological outcomes. Brain biopsy was suggestive of inflammation from thrombosed vessel, and neutrophilic infiltration of cerebellar tissue.

【 授权许可】

Unknown