A Case of Acute Subdural Hematoma associated with Severe COVID-19 under Extracorporeal Membrane Oxygenation (ECMO)
| Autor: | Kei Ito, Masataka Yoshimura, Juri Kiyokawa, Hiroto Yamaoka, Yasuhiro Murota, Yusuke Miwa, Shinji Yamamoto, Mariko Ishikawa, Shin Hirota |
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| Rok vydání: | 2021 |
| Předmět: |
Anisocoria
medicine.medical_specialty medicine.diagnostic_test business.industry medicine.medical_treatment Head injury medicine.disease Surgery surgical procedures operative Hematoma Respiratory failure Modified Rankin Scale Extracorporeal membrane oxygenation medicine Neurology (clinical) medicine.symptom business Craniotomy Computed tomography angiography |
| Zdroj: | Japanese Journal of Neurosurgery. 30:598-603 |
| ISSN: | 2187-3100 0917-950X |
| DOI: | 10.7887/jcns.30.598 |
| Popis: | Patients with Coronavirus disease 2019 (COVID-19) who receive extracorporeal membrane oxygenation (ECMO) tend to show extreme hypercoagulability and require intensive anticoagulant therapy. The prognosis is extremely poor in patients with intracranial hemorrhage. We report a case of COVID-19 complicated by acute subdural hematoma, which necessitated craniotomy for hematoma evacuation to improve the patient's prognosis. A 60-year-old man diagnosed with COVID-19 presented with severe respiratory failure and hypercoagulability and underwent ECMO along with intensive anticoagulant therapy with a large dose of heparin. Physical examination revealed anisocoria secondary to acute subdural hematoma. He denied a history of head injury, and computed tomography angiography revealed no vascular lesions. We diagnosed the patient with a non-traumatic, simple type hematoma. We discussed this case with the attending physician and reviewed the surgical indications and procedures. The attending physician recommended postoperative heparin withdrawal with ECMO. The hematoma was evacuated using a small crani-otomy. Considering the risk of COVID-19, we cautiously performed all intraoperative procedures, especially those associated with aerosol generation, such as irrigation and the use of the craniotome. Heparin was discontinued postoperatively. The modified Rankin scale (mRS) score on postoperative day 90 was mRS 3. Optimal infection control measures prevented nosocomial infections in this patient despite the emergency surgical intervention. |
| Databáze: | OpenAIRE |
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