Non-aneurysmal Perimesencephalic Subarachnoid Hemorrhage in A COVID-19 Patient: Case Report and Review on Subarachnoid Hemorrhage Patterns in COVID-19

Abstract

Background and Importance: The novel SARS-CoV-2 virus has had an undeniable effect worldwide in different aspects. Although cerebrovascular diseases, especially subarachnoid hemorrhage (SAH), have already been reported in COVID-19 patients, little is known about various types and patterns of SAH in these patients. Case Presentation: A 63-year-old woman was admitted to the emergency department with a headache. Her headache was severe (Hunt and Hess score, grade 2). She was diagnosed with COVID-19 by a positive nasopharyngeal swab PCR test. Her CT scan revealed a perimesencephalic hemorrhage, thick SAH without any signs of hydrocephalus or intraventricular hemorrhage. Conclusion: Regarding the different associations of SAH with COVID-19, the perimesencephalic hemorrhage in our case is a novel type. Although not uncommon among non-infected populations, SAH occurrence in COVID-19 patients has not been reported before and needs further investigation.

Nonaneurysmal subarachnoid hemorrhage associated with COVID-19 infection: A case report

“…Numerous reports of viral infections and nonaneurysmal SAH have been associated with COVID-19 caused by SARS-CoV-2, [1][2][3][4]6,7,9,12,16,17,23,24] while some have been associated with other viruses including human immunodeficiency virus, herpes simplex virus, Epstein-Barr virus, Jamestown Canyon virus, and varicella zoster virus. [10,15,21,[25][26][27] Interestingly, there have been no reports of nonaneurysmal SAH caused by coronaviruses other than SARS-CoV-2, such as severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1 or simply SARS-CoV) and Middle East respiratory syndrome…”

“…A literature review revealed 16 cases of nonaneurysmal SAH associated with COVID-19 infection, including ours [ Table 1 ]. [ 1 - 4 , 6 , 7 , 9 , 12 , 16 , 17 , 23 , 24 ] The average age of onset for nonaneurysmal SAH associated with COVID-19 infection was 57 years, similar to SAH due to cerebral aneurysm rupture. There was no gender difference in COVID-19-associated nonaneurysmal SAH, while SAH due to cerebral aneurysm rupture seems to be more common in women.…”