Intracranial Hemorrhage in Hospitalized SARS-CoV-2 Patients: A Case Series

Mousa-Ibrahim, Fady; Berg, Stephanie; Od`TPDetola, Oluwatobi; Teitcher, Michael; Ruland, Sean

doi:10.1016/j.jstrokecerebrovasdis.2020.105428

Cited by 15 publications

(16 citation statements)

References 14 publications

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“…Recently, Mousa-Ibrahim and cols [ 8 ] reported intracranial hemorrhage as well as thrombosis within six COVID-19 patients. Moreover, in an exceptional review study, Pramitasuri and cols.…”

Section: Discussionmentioning

confidence: 99%

High Levels of IL-8 and MCP-1 in Cerebrospinal Fluid of COVID-19 Patients with Cerebrovascular Disease

et al. 2021

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The coronavirus family has tropism for the Central Nervous System (CNS), however, there is no solid evidence demonstrating that the neurological effects of COVID-19 result from direct viral infection or systemic inflammation. The goals of this study were to examine the cytokine profile and the presence of SARS-CoV-2 messenger ribonucleic acid (mRNA) in cerebrospinal fluids (CSF) from two patients with cerebrovascular disease and COVID-19. Although the SARS-CoV-2 mRNA was not detected in CSF of both patients, we found abnormally high levels of numerous proinflammatory cytokines and chemokines, especially IL-8 and MCP-1. Since these chemokines mediate activation and recruitment of neutrophils, monocytes, and macrophages, it is feasible that cerebrovascular disease related-neuroinflammation found in both patients results from an exacerbated inflammatory response instead of SARS-CoV-2 direct invasion to CNS. These results suggest that neuroinflammation plays a key role in cerebrovascular disease and COVID-19.

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“…Recently, Mousa-Ibrahim and cols [ 8 ] reported intracranial hemorrhage as well as thrombosis within six COVID-19 patients. Moreover, in an exceptional review study, Pramitasuri and cols.…”

Section: Discussionmentioning

confidence: 99%

High Levels of IL-8 and MCP-1 in Cerebrospinal Fluid of COVID-19 Patients with Cerebrovascular Disease

et al. 2021

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“…Cerebral hemorrhagic complications and retroperitoneal and adrenal gland hemorrhages have also been described. 17,18 An emerging presentation of COVID-19 can also be hemoptysis. 19,20 Peys et al 19 reported a case of a COVID-19 patient with an acute onset of hemoptysis and alveolar hemorrhage on CT.…”

Section: Discussionmentioning

confidence: 99%

“…Cerebral hemorrhagic complications and retroperitoneal and adrenal gland hemorrhages have also been described. 17 , 18 …”

Section: Discussionmentioning

confidence: 99%

Rare findings of spontaneous hemothorax and small subpleural lung hematoma in a COVID-19 patient: A case report

Brogna

Romano

Tibullo

et al. 2021

Acta Radiologica Open

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Hemothorax (HT) and pulmonary hematoma represent rare complications of anticoagulant therapy. We present a rare case of a 53-year-old man with COVID-19 pneumonia who showed, in a follow-up computed tomography (CT) scan 13 days after hospitalization, a left HT and a small hyperdense area in a subpleural location and compatible with a small subpleural hematoma. This patient was being treated with a subcutaneous administration of low-molecular-weight heparin (100UI/kg/BID). No vascular malformations were visualized on the CT pulmonary angiography. Herein, we report the first case of both a spontaneous HT and a lung subpleural hematoma in a COVID-19 patient, probably caused by anticoagulant therapy.

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“…10,11 CAC is characterised by a prothrombotic state 12 entailing clinical hypercoagulopathy and thromboembolism on the one hand, but also bleeding and intracranial haemorrhage due to endothelial leakage. 13–19 Therefore, anticoagulation in COVID-19 patients is pivotal, and not trivial. 12,20…”

Section: Introductionmentioning

confidence: 99%

Hypercoagulopathy, acquired coagulation disorders and anticoagulation before, during and after extracorporeal membrane oxygenation in COVID-19: a case series

et al. 2021

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Background: Thromboembolism and bleeding contribute to Coronavirus disease 2019 (COVID-19)’s morbidity and mortality and are also frequent complications of venovenous extracorporeal membrane oxygenation (vvECMO). As the interaction of the underlying pathologies caused by vvECMO in COVID-19 is barely understood, we designed this study to better differentiate coagulation disorders in COVID-19 patients before, during and after vvECMO-support. Methods: Observational case series, six consecutive patients with Coronavirus acute respiratory distress syndrome supported with vvECMO treated in the anaesthesiologic ICU in a third level University ECMO-centre. We measured routine coagulation parameters and assessed coagulation factors. We also conducted advanced von Willebrand factor (VWF) multimer analysis, platelet aggregometry and immunological screening. Results: We identified various phases of coagulation disorders: Initially, intensely activated coagulation with highly increased VWF and factor VIII activity in acute COVID-19, then severe acquired von Willebrand syndrome and platelet dysfunction during vvECMO leading to spontaneous bleeding and finally, hypercoagulopathy after vvECMO explantation. Five of six patients developed immunological abnormalities enhancing coagulation. Conclusions: Coronavirus-induced coagulopathy and bleeding disorders during vvECMO cannot be discriminated via ‘routine’ coagulation tests. Precise and specific analyses followed by the appropriate treatment of coagulation disorders may help us develop tailored therapeutic concepts to better manage the phases described above.

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Intracranial Hemorrhage in Hospitalized SARS-CoV-2 Patients: A Case Series

Cited by 15 publications

References 14 publications

High Levels of IL-8 and MCP-1 in Cerebrospinal Fluid of COVID-19 Patients with Cerebrovascular Disease

High Levels of IL-8 and MCP-1 in Cerebrospinal Fluid of COVID-19 Patients with Cerebrovascular Disease

Rare findings of spontaneous hemothorax and small subpleural lung hematoma in a COVID-19 patient: A case report

Hypercoagulopathy, acquired coagulation disorders and anticoagulation before, during and after extracorporeal membrane oxygenation in COVID-19: a case series

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