Development of large contralateral MCA infarct following cranioplasty for decompressive craniectomy for ipsilateral large MCA infarct – A rare case report

A decompressive craniectomy is a life-saving procedure done in cases of cerebral trauma or large infarction. Following decompressive craniectomy, patients undergo cranioplasty for cranial reconstruction. There are various complications associated with cranioplasty but development of contralateral MCA infarct is very rare and not have been reported previously. Case report. Author reported a case of 52 year old female who presented with large right MCA infarct with mass effect and midline shift. Patient underwent decompressive craniectomy with bone flap preservation in abdominal wall. After 3 months, patient underwent autologous cranioplasty. Post-operative course was uneventful. On 5th post-operative day, patient had a GTCS seizure and became unconscious and GCS dropped to E1V1M2. Patient was evaluated with MRI brain which revealed large left MCA infarct with mass effect with midline shift. However, patient deteriorated neurologically and expired on 7th post-operative day. Cranioplasty following decompressive craniectomy is associated with lot of complications. Development of contralateral large MCA infarct following cranioplasty for decompressive craniectomy for ipsilateral large MCA infarct is a very rare complication which has been reported previously. This is life threatening and can lead to death. So, this rare complication should also be kept in mind following cranioplasty.