Decompressive Hemicraniectomy and Suboccipital Craniectomy for Acute Ischemic Stroke

Case Presentation: A female in her late 40 s presented for bilateral lung transplantation for pulmonary hypertension. She was kept sedated postoperatively per standard protocol to limit stress on her cardiopulmonary function. When sedation was lightened, she was noted to have a left hemiparesis and was stroke alerted. CT head demonstrated hypodensity in the right middle cerebral artery territory. CT Perfusion demonstrated completed right-sided MCA infarct. Given her large volume completed infarct, the patient was not a candidate for mechanical thrombectomy. Given the significant mass effect already present, after discussion regarding the risks and benefits of surgery with her family, the patient was taken to the operating room for emergent decompressive hemicraniectomy. She experienced a good neurological recovery and was able to follow commands in all extremities by the time of his discharge albeit with a left-sided hemiparesis. With a plan to perform cranioplasty following inpatient rehabilitation.