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Malignant hemispheric cerebral infarction associated with idiopathic systemic capillary leak syndrome.
[systemic capillary leak syndrome]
Idiopathic
systemic
capillary
leak
syndrome
(
ISCLS
)
is
a
rare
condition
that
is
characterized
by
unexplained
episodic
capillary
hyperpermeability
due
to
a
shift
of
fluid
and
protein
from
the
intravascular
to
the
interstitial
space
.
This
results
in
diffuse
general
swelling
,
fetal
hypovolemic
shock
,
hypoalbuminemia
,
and
hemoconcentration
.
Although
ISCLS
rarely
induces
cerebral
infarction
,
we
experienced
a
patient
who
deteriorated
and
was
comatose
as
a
result
of
massive
cerebral
infarction
associated
with
ISCLS
.
In
this
case
,
severe
hypotensive
shock
,
general
edema
,
hemiparesis
,
and
aphasia
appeared
after
serious
antecedent
gastrointestinal
symptoms
.
Progressive
life-threatening
ischemic
cerebral
edema
required
decompressive
hemicraniectomy
.
The
patient
experienced
another
episode
of
severe
hypotension
and
limb
edema
that
resulted
in
multiple
extremity
compartment
syndrome
.
Treatment
entailed
forearm
and
calf
fasciotomies
.
Cerebral
edema
in
the
ischemic
brain
progresses
rapidly
in
patients
suffering
from
ISCLS
.
Strict
control
of
fluid
volume
resuscitation
and
aggressive
diuretic
therapy
may
be
needed
during
the
post-leak
phase
of
fluid
remobilization
.
Diseases
Validation
Diseases presenting
"edema in the ischemic brain"
symptom
systemic capillary leak syndrome
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