COVID-19 and Intracerebral Hemorrhage

The relationship between coronavirus disease 2019 (COVID-19) and intracerebral hemorrhage remains unclear. Motoie et al. reported a case of severe COVID-19 pneumonia complicated by multiple simultaneous intracerebral hemorrhages (MSICH). The patient died eight days after the episode of MSICH. No apparent coagulopathy was observed; however, extracorporeal membrane oxygenation and anticoagulation might have caused the occurrence of MSICH. Laboratory findings showed hypercoagulability, suggesting that thrombotic etiologies, such as sinus thrombosis or cerebral infarction, might also have caused MSICH. MSICH can occur as a fatal complication of COVID-19, and this should be considered when providing treatment 1).

Kvernland et al. observed an overall low rate of imaging-confirmed hemorrhagic stroke among patients hospitalized with COVID-19. Most hemorrhages in patients with COVID-19 infection occurred in the setting of therapeutic anticoagulation and were associated with increased mortality. Further studies are needed to evaluate the safety and efficacy of therapeutic anticoagulation in patients with COVID-19 2).

Bao et al. reported the clinical features of a COVID-19 patient whose first symptom was cerebral hemorrhage. More importantly, after the craniotomy, the patient had high fever and it was difficult to retreat. After cerebrospinal fluid testing, it was determined that an intracranial infection had occurred. After anti-infection and plasma infusion of the recovered person, the patient's symptoms gradually improved. This case suggests that COVID-19 may infringe on cerebral blood vessels and cause cerebral hemorrhage. Transfusion of plasma from rehabilitation patients is effective for critically ill patients 3).

Khattar et al. reported a 42-year old COVID-19 positive patient with a fatal intracerebral hemorrhage (ICH). The patient presented with fever and dyspnea, requiring intubation due to medical complications. After prolonged sedation and anticoagulation, the patient suddenly developed bilaterally fixed and dilated pupils, caused by a right-sided intracranial hemorrhage with uncal herniation. The course of this case illustrates the delicate balance between hypercoagulability and coagulation factor depletion; especially in the intubated and sedated patient, in whom regular neurological assessments are impeded. As we expand our understanding of the neurological ramifications of COVID-19, clinicians need to be increasingly aware of the precarious coagulation balance 4).

Motoie R, Akai M, Kitahara T, et al. Coronavirus Disease 2019 Complicated by Multiple Simultaneous Intracerebral Hemorrhages [published online ahead of print, 2020 Sep 5]. Intern Med. 2020;10.2169/internalmedicine.5697-20. doi:10.2169/internalmedicine.5697-20
Kvernland A, Kumar A, Yaghi S, et al. Anticoagulation use and Hemorrhagic Stroke in SARS-CoV-2 Patients Treated at a New York Healthcare System [published online ahead of print, 2020 Aug 24]. Neurocrit Care. 2020;1-12. doi:10.1007/s12028-020-01077-0
Bao Y, Lin SY, Cheng ZH, et al. Clinical Features of COVID-19 in a Young Man with Massive Cerebral Hemorrhage-Case Report [published online ahead of print, 2020 May 23]. SN Compr Clin Med. 2020;1-7. doi:10.1007/s42399-020-00315-y
Khattar NK, Sharma M, McCallum AP, et al. Intracranial hemorrhage in a young COVID-19 patient. Interdiscip Neurosurg. 2020;22:100878. doi:10.1016/j.inat.2020.100878
  • covid-19_and_intracerebral_hemorrhage.txt
  • Last modified: 2020/09/07 23:09
  • by administrador