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Article ; Online: COVID-19 and Decompressive Hemicraniectomy for Acute Ischemic Stroke.

Liang, John W / 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 S

Stroke

2020 Volume 51, Issue 9, Page(s) e215–e218

Abstract: ... hemispheric stroke can have a good outcome with decompressive hemicraniectomy. A positive test for COVID-19 ... from early decompressive hemicraniectomy. The impact of concomitant infection with coronavirus disease 2019 ... COVID-19) and how this should weigh in on the decision for surgery is unclear.: Methods ...

Abstract	Background and purpose: Young patients with malignant cerebral edema have been shown to benefit from early decompressive hemicraniectomy. The impact of concomitant infection with coronavirus disease 2019 (COVID-19) and how this should weigh in on the decision for surgery is unclear. Methods: We retrospectively reviewed all COVID-19-positive patients admitted to the neuroscience intensive care unit for malignant edema monitoring. Patients with >50% of middle cerebral artery involvement on computed tomography imaging were considered at risk for malignant edema. Results: Seven patients were admitted for monitoring of whom 4 died. Cause of death was related to COVID-19 complications, and these were either seen both very early and several days into the intensive care unit course after the typical window of malignant cerebral swelling. Three cases underwent surgery, and 1 patient died postoperatively from cardiac failure. A good outcome was attained in the other 2 cases. Conclusions: COVID-19-positive patients with large hemispheric stroke can have a good outcome with decompressive hemicraniectomy. A positive test for COVID-19 should not be used in isolation to exclude patients from a potentially lifesaving procedure.
MeSH term(s)	Adult ; Brain Edema/complications ; Brain Edema/surgery ; Brain Ischemia/complications ; Brain Ischemia/diagnostic imaging ; Brain Ischemia/surgery ; COVID-19 ; Cause of Death ; Clinical Decision-Making ; Coronavirus Infections/complications ; Critical Care ; Decompressive Craniectomy/adverse effects ; Decompressive Craniectomy/methods ; Female ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic ; Neurosurgical Procedures/adverse effects ; Neurosurgical Procedures/methods ; Pandemics ; Pneumonia, Viral/complications ; Retrospective Studies ; Stroke/complications ; Stroke/diagnostic imaging ; Stroke/surgery ; Tomography, X-Ray Computed ; Treatment Outcome
Keywords	covid19
Language	English
Publishing date	2020-07-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/STROKEAHA.120.030804
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Article ; Online: COVID-19 and Decompressive Hemicraniectomy for Acute Ischemic Stroke

Liang, John W. / 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 S.

Stroke

2020 Volume 51, Issue 9

Abstract	Background and Purpose: Young patients with malignant cerebral edema have been shown to benefit from early decompressive hemicraniectomy. The impact of concomitant infection with coronavirus disease 2019 (COVID-19) and how this should weigh in on the decision for surgery is unclear. Methods: We retrospectively reviewed all COVID-19–positive patients admitted to the neuroscience intensive care unit for malignant edema monitoring. Patients with >50% of middle cerebral artery involvement on computed tomography imaging were considered at risk for malignant edema. Results: Seven patients were admitted for monitoring of whom 4 died. Cause of death was related to COVID-19 complications, and these were either seen both very early and several days into the intensive care unit course after the typical window of malignant cerebral swelling. Three cases underwent surgery, and 1 patient died postoperatively from cardiac failure. A good outcome was attained in the other 2 cases. Conclusions: COVID-19–positive patients with large hemispheric stroke can have a good outcome with decompressive hemicraniectomy. A positive test for COVID-19 should not be used in isolation to exclude patients from a potentially lifesaving procedure.
Keywords	Advanced and Specialised Nursing ; Clinical Neurology ; Cardiology and Cardiovascular Medicine ; covid19
Language	English
Publisher	Ovid Technologies (Wolters Kluwer Health)
Publishing country	us
Document type	Article ; Online
ZDB-ID	80381-9
ISSN	1524-4628 ; 0039-2499 ; 0749-7954
ISSN (online)	1524-4628
ISSN	0039-2499 ; 0749-7954
DOI	10.1161/strokeaha.120.030804
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Article: COVID-19 and Decompressive Hemicraniectomy for Acute Ischemic Stroke

Stroke

Abstract	BACKGROUND AND PURPOSE: Young patients with malignant cerebral edema have been shown to benefit from early decompressive hemicraniectomy. The impact of concomitant infection with coronavirus disease 2019 (COVID-19) and how this should weigh in on the decision for surgery is unclear. METHODS: We retrospectively reviewed all COVID-19-positive patients admitted to the neuroscience intensive care unit for malignant edema monitoring. Patients with >50% of middle cerebral artery involvement on computed tomography imaging were considered at risk for malignant edema. RESULTS: Seven patients were admitted for monitoring of whom 4 died. Cause of death was related to COVID-19 complications, and these were either seen both very early and several days into the intensive care unit course after the typical window of malignant cerebral swelling. Three cases underwent surgery, and 1 patient died postoperatively from cardiac failure. A good outcome was attained in the other 2 cases. CONCLUSIONS: COVID-19-positive patients with large hemispheric stroke can have a good outcome with decompressive hemicraniectomy. A positive test for COVID-19 should not be used in isolation to exclude patients from a potentially lifesaving procedure.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #636399
Database	COVID19

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Article ; Online: Malignant cerebral infarction associated with COVID-19 in a child.

Scala, Maria Rosaria / Spennato, Pietro / Cicala, Domenico / Piccolo, Veronica / Varone, Antonio / Cinalli, Giuseppe

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

2021 Volume 38, Issue 2, Page(s) 441–445

Abstract: ... In children, acute ischemic stroke is usually multifactorial: viral infection is an important ... The patient underwent a life-saving decompressive hemicraniectomy, with good functional recovery, except ... Neurological manifestations, such as encephalitis, meningitis, ischemic, and hemorrhagic strokes ...

Abstract	Neurological manifestations, such as encephalitis, meningitis, ischemic, and hemorrhagic strokes, are reported with increasing frequency in patients affected by Coronavirus disease 2019 (COVID-19). In children, acute ischemic stroke is usually multifactorial: viral infection is an important precipitating factor for stroke. We present a case of a child with serological evidence of SARS-CoV-2 infection whose onset was a massive right cerebral artery ischemia that led to a malignant cerebral infarction. The patient underwent a life-saving decompressive hemicraniectomy, with good functional recovery, except for residual hemiplegia. During rehabilitation, the patient also developed a lower extremity peripheral nerve neuropathy, likely related to a long-Covid syndrome.
MeSH term(s)	Brain Ischemia ; COVID-19/complications ; Cerebral Infarction/complications ; Cerebral Infarction/diagnostic imaging ; Child ; Decompressive Craniectomy ; Humans ; Infarction, Middle Cerebral Artery/surgery ; SARS-CoV-2 ; Stroke/surgery ; Treatment Outcome
Language	English
Publishing date	2021-06-26
Publishing country	Germany
Document type	Case Reports ; Journal Article
ZDB-ID	605988-0
ISSN	1433-0350 ; 0302-2803 ; 0256-7040
ISSN (online)	1433-0350
ISSN	0302-2803 ; 0256-7040
DOI	10.1007/s00381-021-05273-x
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Article: Decompressive hemicraniectomy for acute ischemic stroke: A neurosurgical view in a pandemic COVID-19 time highlights of literature.

Bem Junior, Luiz Severo / Ferreira Neto, Otávio da Cunha / Dias, Artêmio José Araruna / Alencar Neto, Joaquim Fechine de / de Lima, Luís Felipe Gonçalves / Lemos, Nilson Batista / Diniz, Andrey Maia Silva / Couto, Kaio Moreira / Maia, Jorge Henrique Estrela Gadelha / Silva, Ana Cristina Veiga / Azevedo Filho, Hildo Rocha Cirne de

Interdisciplinary neurosurgery : Advanced techniques and case management

2022 Volume 28, Page(s) 101485

Abstract: Background and purpose ...

Abstract	Background and purpose
Language	English
Publishing date	2022-01-07
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2785532-6
ISSN	2214-7519
ISSN	2214-7519
DOI	10.1016/j.inat.2021.101485
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Article ; Online: Ischemic Stroke and Vaccine-Induced Immune Thrombotic Thrombocytopenia following COVID-19 Vaccine: A Case Report with Systematic Review of the Literature.

Cascio Rizzo, Angelo / Giussani, Giuditta / Agostoni, Elio Clemente

Cerebrovascular diseases (Basel, Switzerland)

2022 Volume 51, Issue 6, Page(s) 722–734

Abstract: ... mechanical thrombectomy. A malignant infarct occurred in 9 patients and decompressive hemicraniectomy was ... The following keywords were used: ("COVID-19 vaccine") AND ("stroke"), ("COVID-19 vaccine") AND ("thrombotic ... the aorta, peripheral arteries, heart, and brain. Several cases of ischemic stroke have been reported ...

Abstract	Introduction: Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a prothrombotic syndrome observed after adenoviral vector-based vaccines for severe acute respiratory syndrome coronavirus 2. It is characterized by thrombocytopenia, systemic activation of coagulation, extensive venous thrombosis, and anti-platelet factor 4 antibodies. Arterial thrombosis is less common and mainly affects the aorta, peripheral arteries, heart, and brain. Several cases of ischemic stroke have been reported in VITT, often associated with large vessel occlusion (LVO). Here, we describe a case of ischemic stroke with LVO after Ad26.COV2.S vaccine, then we systematically reviewed the published cases of ischemic stroke and VITT following COVID-19 vaccination. Methods: We describe a 58-year-old woman who developed a thrombotic thrombocytopenia syndrome with extensive splanchnic vein thrombosis and ischemic stroke due to right middle cerebral artery (MCA) occlusion, 13 days after receiving Ad26.COV2.S vaccination. Then, we performed a systematic review of the literature until December 3, 2021 using PubMed and EMBASE databases. The following keywords were used: ("COVID-19 vaccine") AND ("stroke"), ("COVID-19 vaccine") AND ("thrombotic thrombocytopenia"). We have selected all cases of ischemic stroke in VITT. Results: Our study included 24 patients. The majority of the patients were females (79.2%) and younger than 60 years of age (median age 45.5 years). Almost all patients (96%) received the first dose of an adenoviral vector-based vaccine. Ischemic stroke was the presenting symptom in 18 patients (75%). Splanchnic venous thrombosis was found in 10 patients, and cerebral venous thrombosis in 5 patients (21%). Most patients (87.5%) had an anterior circulation stroke, mainly involving MCA. Seventeen patients (71%) had an intracranial LVO. We found a high prevalence of large intraluminal thrombi (7 patients) and free-floating thrombus (3 patients) in extracranial vessels, such as the carotid artery, in the absence of underlying atherosclerotic disease. Acute reperfusion therapy was performed in 7 of the 17 patients with LVO (41%). One patient with a normal platelet count underwent intravenous thrombolysis with alteplase, while 6 patients underwent mechanical thrombectomy. A malignant infarct occurred in 9 patients and decompressive hemicraniectomy was performed in 7 patients. Five patients died (21%). Conclusion: Our study points out that, in addition to cerebral venous thrombosis, adenoviral vector-based vaccines also appear to have a cerebral arterial thrombotic risk, and clinicians should be aware that ischemic stroke with LVO, although rare, could represent a clinical presentation of VITT.
MeSH term(s)	Female ; Humans ; Male ; Middle Aged ; Ad26COVS1 ; COVID-19/prevention & control ; COVID-19 Vaccines/adverse effects ; Ischemic Stroke/diagnostic imaging ; Ischemic Stroke/etiology ; Thrombocytopenia ; Thrombosis ; Vaccines
Chemical Substances	Ad26COVS1 (JT2NS6183B) ; COVID-19 Vaccines ; Vaccines
Language	English
Publishing date	2022-05-05
Publishing country	Switzerland
Document type	Case Reports ; Systematic Review
ZDB-ID	1069462-6
ISSN	1421-9786 ; 1015-9770
ISSN (online)	1421-9786
ISSN	1015-9770
DOI	10.1159/000524290
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Zs.A 3181: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article: Decompressive Surgery in the Treatment of Acute Ischemic Stroke during the First Four Waves of the COVID-19 Pandemic in Germany: A Nationwide Observational Cohort Study

Journal of Neurological Surgery Part A: Central European Neurosurgery

2023

Abstract: Background: The COVID-19 pandemic has significantly affected acute ischemic stroke (AIS) care ... to forgo hospitalization during the COVID-19 pandemic. Maintaining the delivery of DS is an essential ... in-hospital processes, and in-hospital mortality rates among patients hospitalized for AIS during the first ...

Abstract	Background: The COVID-19 pandemic has significantly affected acute ischemic stroke (AIS) care. In this study, we examined the effects of the pandemic on neurosurgical AIS care by means of decompressive surgery (DS). Methods: In this retrospective observational study, we compared the characteristics, in-hospital processes, and in-hospital mortality rates among patients hospitalized for AIS during the first four waves of the pandemic (between January 1, 2020 and October 26, 2021) versus the corresponding periods in 2019 (prepandemic). We used administrative data from a nationwide hospital network in Germany. Results: Of the 177 included AIS cases with DS, 60 were from 2019 and 117 from the first four pandemic waves. Compared with the prepandemic levels, there were no changes in weekly admissions for DS during the pandemic. The same was true for patient age (range: 51.7–60.4 years), the number of female patients (range: 33.3–57.1%), and the prevalence of comorbidity, as measured by the Elixhauser Comorbidity Index (range: 13.2–20.0 points). Also, no alterations were observed in transfer to the intensive care unit (range: 87.0–100%), duration of in-hospital stay (range: 14.6–22.7 days), and in-hospital mortality rates (range: 11.8–55.6%). Conclusion: In Germany, compared with the prepandemic levels, AIS patients undergoing DS during the first four waves of the pandemic showed no changes in demographics, rates of comorbidity, and in-hospital mortality rates. This is in contrast to previous evidence on patients with less critical types of AIS not requiring DS and underlines the uniqueness of the subgroup of AIS patients requiring DS. Our findings suggests that these patients, in contrast to AIS patients in general, were unable to forgo hospitalization during the COVID-19 pandemic. Maintaining the delivery of DS is an essential aspect of AIS care during a pandemic.
Keywords	COVID-19 ; acute ischemic stroke ; malignant middle cerebral artery infarction ; decompressive hemicraniectomy
Language	English
Publishing date	2023-08-18
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2651663-9
ISSN	2193-6323 ; 2193-6315
ISSN (online)	2193-6323
ISSN	2193-6315
DOI	10.1055/a-2156-5363
Database	Thieme publisher's database

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Article ; Online: Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke.

Al Saiegh, Fadi / Ghosh, Ritam / Leibold, Adam / Avery, Michael B / Schmidt, Richard F / Theofanis, Thana / Mouchtouris, Nikolaos / Philipp, Lucas / Peiper, Stephen C / Wang, Zi-Xuan / Rincon, Fred / Tjoumakaris, Stavropoula I / Jabbour, Pascal / Rosenwasser, Robert H / Gooch, M Reid

Journal of neurology, neurosurgery, and psychiatry

2020 Volume 91, Issue 8, Page(s) 846–848

Abstract: ... to COVID-19 and later developed an acute-onset severe headache and loss of consciousness and was diagnosed ... a decompressive hemicraniectomy. Both patients' CSF was repeatedly negative on real-time PCR analysis despite ... in the cerebrospinal fluid (CSF) is a topic of debate.: Case description: We present two patients with COVID-19 and ...

Abstract	Background: Emergence of the novel corona virus (severe acute respiratory syndrome (SARS)-CoV-2) in December 2019 has led to the COVID-19 pandemic. The extent of COVID-19 involvement in the central nervous system is not well established, and the presence or the absence of SARS-CoV-2 particles in the cerebrospinal fluid (CSF) is a topic of debate. Case description: We present two patients with COVID-19 and concurrent neurological symptoms. Our first patient is a 31-year-old man who had flu-like symptoms due to COVID-19 and later developed an acute-onset severe headache and loss of consciousness and was diagnosed with a Hunt and Hess grade 3 subarachnoid haemorrhage from a ruptured aneurysm. Our second patient is a 62-year-old woman who had an ischaemic stroke with massive haemorrhagic conversion requiring a decompressive hemicraniectomy. Both patients' CSF was repeatedly negative on real-time PCR analysis despite concurrent neurological disease. Conclusion: Our report shows that patients' CSF may be devoid of viral particles even when they test positive for COVID-19 on a nasal swab. Whether SARS-CoV-2 is present in CSF may depend on the systemic disease severity and the degree of the virus' nervous tissue tropism and should be examined in future studies.
MeSH term(s)	Adult ; Betacoronavirus/isolation & purification ; COVID-19 ; Coronavirus Infections/cerebrospinal fluid ; Coronavirus Infections/complications ; Female ; Humans ; Male ; Middle Aged ; Pandemics ; Pneumonia, Viral/cerebrospinal fluid ; Pneumonia, Viral/complications ; SARS-CoV-2 ; Stroke/cerebrospinal fluid ; Stroke/complications ; Stroke/virology
Keywords	covid19
Language	English
Publishing date	2020-04-30
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	3087-9
ISSN	1468-330X ; 0022-3050
ISSN (online)	1468-330X
ISSN	0022-3050
DOI	10.1136/jnnp-2020-323522
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Article ; Online: Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke

Journal of Neurology, Neurosurgery & Psychiatry

2020 Volume 91, Issue 8, Page(s) 846–848

Abstract: ... who had an ischaemic stroke with massive haemorrhagic conversion requiring a decompressive hemicraniectomy ... in the cerebrospinal fluid (CSF) is a topic of debate. Case description We present two patients with COVID-19 and concurrent ... neurological symptoms. Our first patient is a 31-year-old man who had flu-like symptoms due to COVID-19 and later ...

Abstract	Background Emergence of the novel corona virus (severe acute respiratory syndrome (SARS)-CoV-2) in December 2019 has led to the COVID-19 pandemic. The extent of COVID-19 involvement in the central nervous system is not well established, and the presence or the absence of SARS-CoV-2 particles in the cerebrospinal fluid (CSF) is a topic of debate. Case description We present two patients with COVID-19 and concurrent neurological symptoms. Our first patient is a 31-year-old man who had flu-like symptoms due to COVID-19 and later developed an acute-onset severe headache and loss of consciousness and was diagnosed with a Hunt and Hess grade 3 subarachnoid haemorrhage from a ruptured aneurysm. Our second patient is a 62-year-old woman who had an ischaemic stroke with massive haemorrhagic conversion requiring a decompressive hemicraniectomy. Both patients’ CSF was repeatedly negative on real-time PCR analysis despite concurrent neurological disease. Conclusion Our report shows that patients’ CSF may be devoid of viral particles even when they test positive for COVID-19 on a nasal swab. Whether SARS-CoV-2 is present in CSF may depend on the systemic disease severity and the degree of the virus’ nervous tissue tropism and should be examined in future studies.
Keywords	Surgery ; Psychiatry and Mental health ; Clinical Neurology ; covid19
Language	English
Publisher	BMJ
Publishing country	uk
Document type	Article ; Online
ZDB-ID	3087-9
ISSN	1468-330X ; 0022-3050
ISSN (online)	1468-330X
ISSN	0022-3050
DOI	10.1136/jnnp-2020-323522
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke

J Neurol Neurosurg Psychiatry

Abstract: ... who had an ischaemic stroke with massive haemorrhagic conversion requiring a decompressive hemicraniectomy ... in the cerebrospinal fluid (CSF) is a topic of debate. CASE DESCRIPTION: We present two patients with COVID-19 and concurrent ... neurological symptoms. Our first patient is a 31-year-old man who had flu-like symptoms due to COVID-19 and later ...

Abstract	BACKGROUND: Emergence of the novel corona virus (severe acute respiratory syndrome (SARS)-CoV-2) in December 2019 has led to the COVID-19 pandemic. The extent of COVID-19 involvement in the central nervous system is not well established, and the presence or the absence of SARS-CoV-2 particles in the cerebrospinal fluid (CSF) is a topic of debate. CASE DESCRIPTION: We present two patients with COVID-19 and concurrent neurological symptoms. Our first patient is a 31-year-old man who had flu-like symptoms due to COVID-19 and later developed an acute-onset severe headache and loss of consciousness and was diagnosed with a Hunt and Hess grade 3 subarachnoid haemorrhage from a ruptured aneurysm. Our second patient is a 62-year-old woman who had an ischaemic stroke with massive haemorrhagic conversion requiring a decompressive hemicraniectomy. Both patients' CSF was repeatedly negative on real-time PCR analysis despite concurrent neurological disease. CONCLUSION: Our report shows that patients' CSF may be devoid of viral particles even when they test positive for COVID-19 on a nasal swab. Whether SARS-CoV-2 is present in CSF may depend on the systemic disease severity and the degree of the virus' nervous tissue tropism and should be examined in future studies.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #154812
Database	COVID19

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