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J Neuroophthalmol ; 41(4): e761-e763, 2021 Dec 01.
Article in English | MEDLINE | ID: covidwho-1232245

ABSTRACT

ABSTRACT: It is recommended that every patient with a new third nerve palsy undergo urgent neuroimaging (computed tomography angiography or magnetic resonance angiography) to exclude a posterior communicating artery aneurysm. Because of the novel coronavirus (COVID-19) pandemic, our institution noted a significant decline in the number of patients with aneurysmal subarachnoid hemorrhage presenting to the hospital. We report one such example of a patient who developed new-onset severe headache and vomiting and did not seek medical attention because of COVID-19. Two months later, she was noted to have ptosis during a routine follow-up and was found to have a complete, pupil-involving third nerve palsy. Computed tomography angiography was performed and revealed an irregular bilobed saccular aneurysm (7 × 9 × 5 mm) of the right posterior communicating (PComm) artery, but no acute hemorrhage was visible on CT. On MRI, immediately adjacent to the aneurysm, there was a small subacute hematoma in the right medial temporal lobe with surrounding vasogenic edema. This case had a fortunate and unique outcome as she had a contained hematoma adjacent to the ruptured PComm aneurysm and did not experience severe morbidity from the subarachnoid hemorrhage nor did she rebleed in the interval in which she did not seek care. This case highlights the importance of providing neuro-ophthalmic care even during a pandemic.


Subject(s)
Aneurysm, Ruptured/diagnostic imaging , COVID-19/complications , Intracranial Aneurysm/diagnostic imaging , Oculomotor Nerve Diseases/diagnostic imaging , Aged , Aneurysm, Ruptured/complications , Cerebral Angiography , Female , Humans , Intracranial Aneurysm/complications , Magnetic Resonance Angiography , Oculomotor Nerve Diseases/complications
2.
World Neurosurg ; 138: e955-e960, 2020 06.
Article in English | MEDLINE | ID: covidwho-274866

ABSTRACT

OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) pandemic poses a substantial threat to the health of health care personnel on the front line of caring for patients with COVID-19. The Centers for Medicare and Medicaid Services have announced that all nonessential planned surgeries and procedures should be postponed until further notice and only urgent procedures should proceed. Neurologic surgeries and procedures should not be delayed under the circumstance in which it is essential at saving a life or preserving functioning of the central nervous system. METHODS: With the intent to advise the neurosurgery team on how to adequately prepare and safely perform neurosurgical procedures on confirmed and suspected patients with COVID-19, we discuss considerations and recommendations based on the lessons and experience shared by neurosurgeons in China. RESULTS: Perioperative and intraoperative strategies, considerations, as well as challenges arisen under the specific circumstance have been discussed. In addition, a case of a ruptured aneurysm in a suspected patient with COVID-19 is reported. It is advised that all health care personnel who immediately participate in neurosurgical surgeries and procedures for confirmed and suspected patients with COVID-19 should take airborne precautions and wear enhanced personal protective equipment. CONCLUSIONS: Following the proposed guidance, urgent neurosurgical surgeries and procedures can be safely performed for the benefit of critical patients with or suspected for COVID-19.


Subject(s)
Aneurysm, Ruptured/surgery , Coronavirus Infections/diagnosis , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intracranial Aneurysm/surgery , Neurosurgical Procedures/methods , Pneumonia, Viral/diagnosis , Subarachnoid Hemorrhage/surgery , Air Filters , Aneurysm, Ruptured/complications , Aneurysm, Ruptured/diagnostic imaging , Betacoronavirus , COVID-19 , COVID-19 Testing , China , Clinical Laboratory Techniques , Computed Tomography Angiography , Coronavirus Infections/complications , Craniotomy/methods , Drainage , Emergencies , Hematoma/complications , Hematoma/diagnostic imaging , Hematoma/surgery , Humans , Intracranial Aneurysm/complications , Intracranial Aneurysm/diagnostic imaging , Intracranial Pressure , Intraoperative Care , Lung/diagnostic imaging , Monitoring, Physiologic , Operating Rooms , Pandemics , Perioperative Care , Personal Protective Equipment , Pneumonia, Viral/complications , Practice Guidelines as Topic , SARS-CoV-2 , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/diagnostic imaging , Tomography, X-Ray Computed , United States
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