ABSTRACT
Patients with Coronavirus disease 2019 (COVID-19) who receive extracorporeal membrane oxygenation (ECMO) tend to show extreme hypercoagulability and require intensive anticoagulant therapy. The prognosis is extremely poor in patients with intracranial hemorrhage. We report a case of COVID-19 complicated by acute subdural hematoma, which necessitated craniotomy for hematoma evacuation to improve the patient's prognosis. A 60-year-old man diagnosed with COVID-19 presented with severe respiratory failure and hypercoagulability and underwent ECMO along with intensive anticoagulant therapy with a large dose of heparin. Physical examination revealed anisocoria secondary to acute subdural hematoma. He denied a history of head injury, and computed tomography angiography revealed no vascular lesions. We diagnosed the patient with a non-traumatic, simple type hematoma. We discussed this case with the attending physician and reviewed the surgical indications and procedures. The attending physician recommended postoperative heparin withdrawal with ECMO. The hematoma was evacuated using a small crani-otomy. Considering the risk of COVID-19, we cautiously performed all intraoperative procedures, especially those associated with aerosol generation, such as irrigation and the use of the craniotome. Heparin was discontinued postoperatively. The modified Rankin scale (mRS) score on postoperative day 90 was mRS 3. Optimal infection control measures prevented nosocomial infections in this patient despite the emergency surgical intervention.