A 61-year-old right-handed patient with a history of untreated type II diabetes mellitus.
He was admitted 3 h after waking up with severe dysarthria, phago-brachio-crural hemiplegia, hemianesthesia and left hemianopsia.
The rest of the test was normal.
Computed tomography (CT) showed early signs of right MMI.
Due to the extension of the infarction, the possibility of performing HD to prevent enclaving and death of the patient was discussed.
Given the exceptional nature of the procedure, the risks and benefits were discussed with direct relatives, who understood and accepted the intervention.
The etiologic study consisted of carotid ultrasound, transthoracic echocardiography and arrhythmia Holter, which were normal.
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At 72 h, she suffered from rigidity of profound bilateral descent associated with mydriasis.
A control CT was performed and the patient underwent an emergency HD.
Postoperative CT showed right frontal intraparenchymatous hemorrhage, probably due to venous infarction secondary to insufficient craniectomy.
The patient was discharged after 20 days with intensive rehabilitation and aspirin (325 mg/day).
He was readmitted to the sixth month for the installation of the bone platelet (stored in the bone bank), which was performed without complications and was discharged on the eighth day.
At 6 months she had 2 seizures, phenytoin was indicated (300 mg/day).
She has not had seizures anymore.
1.
After two years of evolution, the patient ambulation supported by a basket presented a brachial plejia and left hemianopsia.
She dressed and goes to her family's helped bathroom, but eats alone (modified Rankin scale= 3).
