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VOLUME 26 , ISSUE 2 ( February, 2022 ) > List of Articles


Corona, Acute Ischemic Stroke, Malignant Cerebral Edema, and Hemo-adsorption: A Case Report

Zakaria Kaidawala, Arun Shah, Rushi Desphande

Keywords : Acute ischemic stroke, Corona, COVID-19, Cytosorb, Hemoadsorption, Hemoperfusion, Malignant cerebral edema

Citation Information : Kaidawala Z, Shah A, Desphande R. Corona, Acute Ischemic Stroke, Malignant Cerebral Edema, and Hemo-adsorption: A Case Report. Indian J Crit Care Med 2022; 26 (2):235-238.

DOI: 10.5005/jp-journals-10071-24116

License: CC BY-NC 4.0

Published Online: 09-02-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: COVID-19 infection can be associated with systemic hyperinflammation, hypercoagulable state, vasculitis, and cardiomyopathy leading to multiorgan failure. Use of extracorporeal blood purification has been shown to mitigate the cytokine storm, improving hemodynamic stability and pulmonary function. Case summary: We report a case of a young patient with malignant cerebral edema due to acute cerebrovascular accident, with COVID-19. He was taken up for life-saving decompression craniotomy amidst the cytokine storm and multiorgan failure, and was treated with steroids, antibiotics, and Cytosorb® therapy for the cytokine storm. IL-6 and PCT levels were reduced by 99.5 and 98.6%, respectively. Vasopressors were stopped on day 4 and successfully weaned off ventilator support by 2 weeks of tracheostomy. He was de-cannulated and discharged neurologically stable on day 32. Conclusion: Timely detection of COVID-19 and anti-inflammatory and hemo-adsorption measures may be helpful in modulating cytokine storm, thereby reducing morbidity and mortality.

  1. Spence JD, De Freitas GR, Pettigrew LC, Ay H, Liebeskind DS, Kase CS, et al. Mechanisms of stroke in COVID-19. Cerebrovasc Dis 2020;49(4):451–458. DOI: 10.1159/000509581.
  2. Tang Y, Liu J, Zhang D, Xu Z, Ji J, Wen C. Cytokine storm in COVID-19: the current evidence and treatment strategies. Front Immunol 2020;11:1708. DOI: 10.3389/fimmu.2020.01708.
  3. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020;46(5):846–848. DOI: 10.1007/s00134-020-05991-x.
  4. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229): 1054–1062. DOI: 10.1016/S0140-6736(20)30566-3.
  5. George MR. Hemophagocytic lymphohistiocytosis: review of etiologies and management. J Blood Med 2014;5:69–86. DOI: 10.2147/JBM.S46255.
  6. Napp LC, Bauersachs J. Extracorporeal hemoperfusion: an option for COVID-19-associated cytokine storm syndrome. Shock 2020;54(5):700–701. DOI: 10.1097/SHK.0000000000001568.
  7. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis 2020;71(15):762–768. DOI: 10.1093/cid/ciaa248.
  8. Rimmelé T, Kellum JA. Clinical review: blood purification for sepsis. Critical Care 2011;15(1):1–10. DOI: 10.1186/cc9411.
  9. Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, et al. Neurological associations of COVID-19. Lancet Neurol 2020;19(9): 767–783. DOI: 10.1016/S1474-4422(20)30221-0.32.
  10. Tahaghoghi-Hajghorbani S, Zafari P, Masoumi E, Rajabinejad M, Jafari-Shakib R, Hasani B, et al. The role of dysregulated immune responses in COVID-19 pathogenesis. Vir Res 2020;290:198197. DOI: 10.1016/j.virusres.2020.198197.
  11. Merrill JT, Erkan D, Winakur J, James JA. Emerging evidence of a COVID-19 thrombotic syndrome has treatment implications. Nat Rev Rheumatol 2020;16:581–589. DOI: 10.1038/s41584-020-0474-5.
  12. Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP, et al. Large-vessel stroke as a presenting feature of COVID-19 in the young. N Engl J Med 2020;382:e60. DOI: 10.1056/NEJMc2009787.
  13. Liang JW, Reynolds AS, Kaitlin Reilly K, Lay C, Kellner CP. COVID-19 and decompressive hemicraniectomy for acute ischemic stroke. Stroke 2020;51:e215–e218. DOI: 10.1161/STROKEAHA.120.030804.
  14. Sáez-Alegre M, García-Feijoo P, Millán P, Vivancos Sánchez C, Rodríguez Domínguez V, García Nerín J, et al. Case report: decompressive craniectomy for COVID-19 malignant cerebral artery infarction. Is surgery a good option? Front Neurol 2021;12: 632036. DOI: 10.3389/fneur.2021.632036.
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