Reversible malignant cerebral edema following cranioplasty

A 44-year-old female underwent cranioplasty 6 months after a malignant right MCA stroke. Three hours later, she became unresponsive, with new left-gaze deviation and right-side hemiparesis. CT head showed new right MCA hypodensity and diffuse edema. After aggressive medical management, she returned to baseline. A brain MRI showed no stroke. Malignant cerebral edema after uneventful cranioplasty is a rare and often fatal complication related to sudden intracranial negative pressure and altered cerebral autoregulation. This is a rare case in which a patient developed malignant cerebral edema and status epilepticus after cranioplasty and survived.