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

Interdiscip Neurosurg. 2020 Dec:22:100850. doi: 10.1016/j.inat.2020.100850. Epub 2020 Jul 29.

Abstract

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.

Keywords: ARDS, acute respiratory distress syndrome; BiPaP, Bilevel positive airway pressure; COVID 19, Corona Virus Disease 2019; COVID-19; CP, cerebellopontine; CRP, C-reactive protein; CT, computed tomography; CTA, CT angiography; CXR, chest X-ray; Coronavirus; FiO2, fraction of inspired oxygen; Ischemic stroke; Phlebitis; SARS-COV-2; SARS-COV-2, severe acute respiratory syndrome coronavirus 2; STAT, statum which is Latin meaning immediately; Sub-occipital craniectomy; Vasculitis; WHO, World Health Organization; t-PA, tissue plasminogen activator.

Publication types

  • Case Reports