# Iatrogenic Cranial Pseudomeningocele on the Stroke Unit: A Lesser-Known Potential Complication After Decompressive Hemicraniectomy Following Malignant Middle Cerebral Artery Syndrome

## TL;DR

A rare complication called pseudomeningocele occurred after a brain surgery for stroke, requiring careful management and teamwork to ensure a good recovery.

## Contribution

Highlights pseudomeningocele as a lesser-known complication of decompressive hemicraniectomy in stroke patients.

## Key findings

- Pseudomeningocele developed after decompressive hemicraniectomy in a patient with malignant MCA syndrome.
- Effective management involved CSF drainage and cranioplasty, leading to a successful recovery.
- Multidisciplinary collaboration is crucial to prevent neurological complications.

## Abstract

This case report presents a rare complication of a large pseudomeningocele following decompressive hemicraniectomy in a young gentleman with malignant middle cerebral artery (MCA) syndrome after a large anterior circulation ischemic stroke. Our patient responded to the cerebrospinal fluid (CSF) drain before proceeding to an interval cranioplasty and made an excellent recovery over time and with vocational neurorehabilitation. Our report charts the patient's clinical journey, including diagnostic assessment, management, and outcome, and highlights the challenges in managing this uncommon complication in the stroke unit. It also underlines the need for multidisciplinary collaboration and early neurosurgical involvement in managing this complication to prevent unfavourable neurological sequelae.