Cardiac arrest due to brain herniation secondary to massive ische | 60043
Clinical & Experimental Cardiology

Clinical & Experimental Cardiology
Open Access

ISSN: 2155-9880

Cardiac arrest due to brain herniation secondary to massive ischemic stroke in COVID-19 patient: Should routine neurological screening be done frequently for all patients with COVID-19 infection?

36th European Cardiology Conference

November 01-02,2021 WEBINAR

Nghi Tran, Chuong Le1, Luna Tsang, Steven Pham, Khiet T. Nguyen, Thoai Nguyen, Han L. Nguyen, San Tran, Thanh Hoang, Ritu Bhardwaj, Ngan N. T. Mai , Vien Phan, Duy Nguyen, Mai Nguyen, Evelyn Huynh, Phillip Tran

University of Medicine and Pharmacy, Vietnam
Arizona College of Osteopathic Medicine at Midwestern University, AZ, USA
University College of Osteopathic Medicine, USA
Mount Sinai Hospital Medical Center, USA
Vietnam Military Medical University, Vietnam
Saint James School of Medicine, USA
Pham Ngoc Thach University of Medicine, Vietnam
Kansai Medical University, Osaka, Japan
San Diego State University, USA
Drake University, USA
University of California Davis, USA
Yavapai Regional Medical Center, USA
Nam Can Tho University, Vietnam

Posters & Accepted Abstracts: J Clin Exp Cardiolog

Abstract :

Case: A 36-year-old male without significant medical history presented with dyspnea that quickly desaturated and required mechanical ventilation. Chest x-ray showed extensive bilateral infiltrates (figure 1). COVID-19 PCR test was positive, and patient was diagnosed with pneumonia secondary to COVID-19 infection. Unfortunately, he developed cardiac arrest with bradycardia and asystole. EKG showed sinus tachycardia (figure 2). Troponin was elevated to 5.27 ng/ml and D-dimer was significantly elevated to over 20 ng/ml. Massive pulmonary embolism was highly suspected. However, a chest CT angiogram was contraindicated due to his acute kidney failure, so empirical tissue plasminogen activator (tPA) treatment was commenced given the absence of ongoing bleeding. On hospitalization day two, he had no response to sedation. The head CT-scan showed no intracranial hemorrhage, yet numerous infarcts and diffuse cerebral edema with right-sided subfalcine and bilateral transtentorial herniations were noticed (figure 3). Additionally, EEG showed severe encephalopathy. Eventually, his family elected for compassionate extubation. Literature Review: Ischemic stroke in COVID-19 patients was reported in up to 6% of critically ill patients [1]. The underlying pathophysiology for ischemic stroke in COVID-19 patient can be due to hypercoagulation [4]. Unique aspect: This patient's cardiac arrest could result from brain herniation due to massive edema, secondary to multiple infarcts from hypercoagulable state in COVID-19 patients. Recommendations: In COVID-19 patients, neurologic evaluations should be performed regularly to address ischemic stroke promptly by doing a head CT. Conclusions: Several reported disease processes were accused of causing cardiac arrest in COVID-19 patients, yet brain herniation secondary to multiple infarcts can also be the culprit.