How Does the Brain Die After a Massive Posterior Fossa Lesion?

• Published in: Neurocritical care Vol. 34; no. 2; pp. 686 - 690
• Main Authors: Marcellino, Chris, Braksick, Sherri A., Wijdicks, Eelco F. M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-04-2021; Springer Nature B.V
• Subjects: Anesthesia; Blood & organ donations; Brain; Brain death; Compression therapy; Coronaviruses; COVID-19; Cranial Fossa, Posterior; Critical Care Medicine; Edema; Hospitalization; Humans; Hydrocephalus; Intensive; Internal Medicine; Medical imaging; Medicine; Medicine & Public Health; Neuro-Images; Neurology; Neurosurgery; Patients; Pneumonia; Sinuses; Thrombosis
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-020-01147-3

Description of the Case A 61-year-old woman with a pertinent history of metabolic syndrome was hospitalized due to severe hypoxemia from COVID-19 pneumonia, diagnosed by positive nasal swab for SARS-CoV-2 and typical ground glass opacities on chest computed tomography (CT) imaging. CT of the head was performed, which showed a large right cerebellar intraparenchymal hemorrhage with extensive mass effect resulting in basilar cistern effacement and upward transtentorial herniation (Fig. 1a). See PDF.] Axial CT head images from the 12th day of hospitalization a probable established right PICA territory infarction or posterior fossa venous sinus thrombosis with hemorrhagic conversion (measuring 3.5 × 2.9 cm on coronal images) resulting in basilar cistern effacement and upward transtentorial herniation. b–d Early loss of gray–white differentiation isolated to the posterior fossa and tri-ventricular hydrocephalus is seen in higher slices. Multiple cerebellar and brainstem infarcts and mass effect from hemorrhagic conversion of the right cerebellum rapidly produces progressive and extensive loss of brainstem function (Fig. 1a, b).