Decompressive Hemicraniectomy and Favorable Outcome in a Pediatric Patient with Malignant Middle Cerebral Artery Infarction
Table 1
Initial diagnostic workup.
Study
Results
CBC
WBC 15.7 cells/L, HB 10.9 gm/dL
HCT 34.1 L/L, PLT 362 per microL
CMP
Na+ 140 mEq/L, K+ 3.6 mEq/L, Ca 8.7 mg/dL
BUN 6 mg/dL, creatinine 0.42 mg/dL
PT
13.9 seconds
INR
1
APTT
27 seconds
Fibrinogen
357 mg/dL
Lipid panel
LDL 117 mg/dL/HDL 31 mg/dL
POCT glucose
98 mmol/L
MTHFR, DNA
C667T- detected heterozygous
A1298 C—not detected
Homocysteine total
5.4 µmol/L
Lactate level
0.48 mmol/L
Protein C
107 µg/ml
Protein S functional
95%
Lupus anticoagulation panel
Not detected
Antiphospholipid antibody panel
Negative
Factor leiden
Negative
Anti-ds DNA antibody
Negative
Sjogren’s abs
Negative
Sickle cell screen
Negative
APC resistance
2.5
ATIII
80%
Factor II, DNA
Negative
Antixa assay
0.7 units/mL
Factor 8
214%
COVID-19 IgG/IgM antibody
Negative
Urine drug screen
Benzodiazepine
CBC= Complete blood count. CMP= Complete metabolic profile. PT= Prothrombin time. INR= International normalized ratio. APTT = Activated partial prothrombin time. POCT= Point of care testing. MTHFR, DNA = Methylenetetrahydrofolate reductase. Anti-Ds DNA = Anti-double stranded DNA. APC = Activated protein C. ATIII = Antithrombin III. AntiXa = Anti-factor Xa. This result is not associated with an increased risk for hyperhomocysteinemia. Low-normal, not clinically relevant. Thrombophilia workup negative. Received intravenous benzodiazepine for suspected seizure/agitation on initial presentation.
