In this paper, the authors retrospectively reviewed all COVID-19–positive patients admitted to the neuroscience intensive care unit for monitoring of malignant cerebral oedema.
Patients with >50% of middle cerebral artery involvement on computed tomography imaging were considered at risk for malignant oedema. Seven patients were admitted for monitoring, of whom 4 died. The cause of death was related to COVID-19 complications, and these were either seen 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 post-operatively from cardiac failure. A good outcome was attained in the other 2 cases. The authors concluded that 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.