Response to comments on: Neuro-ophthalmic presentation of COVID-19 disease: A case report

Abstract

The concern regarding the pathophysiology of hemorrhage in pituitary macroadenoma -Alteration of vasoregulation in viremia, due to attack of SARS-CoV2 viruses at ACE2 receptors has already been described in detail in the manuscript. [1] The study pointed out by authors Syahrul S et al. published in Jan 2021 also describes multiple possible pathophysiologies behind hemorrhagic events in COVID-19, which is mainly associated with the elevation of Angiotensin II levels, which is an event subsequent to SARS-CoV-2 occupation of the ACE2 receptor. [3,4] This recent study also points out cytokine storm-related activity affecting extracellular matrix and cell junctions as possible factors for hemorrhage. However, we want to make it clear that apoplexy can be due to all explained reasons in COVID-19; also, inflammation itself can act as a precipitating factor for apoplexy in this case.