Acute global ischemic stroke after cranioplasty: case report and review of the literature.

INTRODUCTION

Cranioplasty procedures are performed usually after devastating neurological injuries requiring craniectomies. Although relatively safe, global intracerebral infarction is a poorly understood, and most often, lethal complication after cranioplasty. We report here one such case with a thorough literature review with insight as to possible etiologies of this injury.

CASE REPORT

A 14-year-old girl underwent a left-sided decompressive hemicraniectomy for treatment of a subdural hematoma and cerebral edema. The patient's neurological condition eventually improved and she presented for cranioplasty repair of the defect 83 days after her initial operation. Six hours after an uneventful procedure, the patient's neurological examination declined. Immediate CT scan revealed global edema. Despite all treatment measures, the patient progressed to global ischemia and brain death and expired.

CONCLUSIONS

Although global intracerebral infarction after cranioplasty is extremely rare, the concepts of vessel injury, venous stasis, and reperfusion into dysfunctional cerebral tissue after cranioplasty should be considered when evaluating the risk of this procedure.