Intracranial Hemorrhage in COVID-19 Patients

Mishra, Sanskriti; Choueka, Murray; Wang, Qiang; Hu, Chloe; Visone, Stephanie; Silver, Michael; Stein, Evan G.; Levine, Steven R.; Wang, Qingliang T.

doi:10.1016/j.jstrokecerebrovasdis.2021.105603

Cited by 29 publications

(33 citation statements)

References 49 publications

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“… 76 , 77 Further studies are required to determine whether prophylactic anticoagulation specifically reduces the risk of stroke in COVID-19, particularly because of reports of haemorrhagic stroke in hospitalized patients while receiving therapeutic anticoagulation. 78 Indeed, the risk of haemorrhagic stroke is higher than predicted among COVID-19 patients 79 and is associated with elevated serum ferritin. 16 Similarly, microhemorrhages 50 and acute haemorrhagic necrotizing encephalitis have been reported in patients with COVID-19.…”

Section: Acute Neurological Syndromesmentioning

confidence: 99%

Acute and chronic neurological disorders in COVID-19: potential mechanisms of disease

Balcom

Nath

Power

2021

Brain

133

138

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COVID-19 is a global pandemic caused by SARS-CoV-2 infection and is associated with both acute and chronic disorders affecting the nervous system. Acute neurological disorders affecting patients with COVID-19 range widely from anosmia, stroke, encephalopathy/encephalitis, and seizures to Guillain-Barre Syndrome. Chronic neurological sequelae are less well defined although exercise intolerance, dysautonomia, pain, as well as neurocognitive and psychiatric dysfunctions are commonly reported. Molecular analyses of cerebrospinal fluid and neuropathological studies highlight both vascular and immunologic perturbations. Low levels of viral RNA have been detected in the brains of few acutely ill individuals. Potential pathogenic mechanisms in the acute phase include coagulopathies with associated cerebral hypoxic-ischemic injury, blood-brain barrier abnormalities with endotheliopathy and possibly viral neuroinvasion accompanied by neuro-immune responses. Established diagnostic tools are limited by a lack of clearly defined COVID-19 specific neurological syndromes. Future interventions will require delineation of specific neurological syndromes, diagnostic algorithm development, and uncovering the underlying disease mechanisms that will guide effective therapies.

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Section: Acute Neurological Syndromesmentioning

confidence: 99%

Acute and chronic neurological disorders in COVID-19: potential mechanisms of disease

Balcom

Nath

Power

2021

Brain

133

138

View full text Add to dashboard Cite

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“…Since patients affected by SARS-CoV-2 infection present coagulation and immune system dysregulation, stroke is not uncommon, regarding 0.9–2.7% of all COVID-19 cases, irrespective of respiratory distress. Spontaneous intracranial haemorrhage accounts for about 20% of all COVID-19 strokes and is often associated with severe pneumonia [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome and brain haemorrhage as COVID-19 complication: a review of the available literature

et al. 2021

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Background SARS-CoV-2 infection has been associated with various neurological manifestations. Since patients affected by SARS-CoV-2 infection present coagulation and immune system dysregulation, ischemic or haemorragic stroke is not uncommon, irrespective of respiratory distress. However, the occurrence of focal neurological deficits together with other symptoms like headache, cortical blindness, seizure and altered mental status should prompt the diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES). Antithrombotic treatment, the alteration of endothelial function, and coagulopathy due to COVID-19 and PRES leading to the breakdown of blood-brain barrier may then contribute to the occurrence of a brain haemorrhage. Methods We describe the case of a COVID-19 patient who developed bilateral occipital lobe haemorrhages suggestive of haemorrhagic PRES. We then reviewed the available literature about haemorrhagic evolution of PRES in COVID-19. Results We describe the clinical and radiological features of five COVID-19 patients who developed haemorrhagic PRES. Conclusions Coagulopathy and endothelial dysfunction resulting from the massive release of cytokines during the host immune response may be key factors in the pathogenesis of COVID-19-related PRES. Antithrombotic therapy and the leakage of the blood-brain barrier can subsequently increase the risk of haemorrhagic transformation of the lesioned brain tissue. A prompt diagnosis of PRES is mandatory, since the timely interruption/reversal of antithrombotic therapy may be a key determinant for a good prognosis.

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“…[15] Several reports of SAH in COVID-19 patients are present in the literature (summarized in Table 1). [10,11,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] SARS-CoV-2 may gain access to CNS via two principal routes, namely the hematogenous and the retrograde neuronal (axonal) dissemination. In the hematogenous entry, SARS-CoV-2 may enter the CNS through the blood-brain barrier (BBB) by any of the three mechanisms-(1) by direct entry into CNS via infection of the endothelial cells, (2) via angiotensin-converting enzyme-2 (ACE-2) receptors expressed on the endothelium, or (3) via migration by infecting the monocytes and macrophages.…”

Section: Deathmentioning

confidence: 99%

Non-Aneurysmal Subarachnoid Hemorrhage in COVID-19: A Case Report and Review of Literature

Ray

Roy

Ghosh

et al. 2022

MRAJ

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Background: Hemorrhagic cerebrovascular events, either due to aneurysmal rupture or spontaneous subarachnoid hemorrhage (SAH), are not rare in COVID-19. Several mechanisms such as coagulopathy, cytokine storm, viral endotheliopathy, hypertension, and immune modulation might play a role in the pathogenesis of SAH in COVID-19. This study aimed to report the first case of spontaneous non-aneurysmal SAH associated with SARS-CoV-2 from India. We briefly discussed the possible pathogenetic mechanisms underlying this process and succinctly reviewed the relevant literature. Case report: We herein report a case of a non-comorbid young woman infected with SARS-CoV-2 presenting with thunderclap headache and eventually non-aneurysmal SAH, who recovered with conservative management. Conclusion: Headache, although a very common clinical feature of COVID-19 itself, must be investigated in detail to identify alternate causes that may be life-threatening. This case also incites further enquiry into the possible pathogenic mechanisms of neurovascular complications in COVID-19.

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Intracranial Hemorrhage in COVID-19 Patients

Cited by 29 publications

References 49 publications

Acute and chronic neurological disorders in COVID-19: potential mechanisms of disease

Acute and chronic neurological disorders in COVID-19: potential mechanisms of disease

Posterior Reversible Encephalopathy Syndrome and brain haemorrhage as COVID-19 complication: a review of the available literature

Non-Aneurysmal Subarachnoid Hemorrhage in COVID-19: A Case Report and Review of Literature

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