Subarachnoid hemorrhage and COVID-19

Abstract

Some evidences suggest the involvement of the central nervous system in patients infected with SARS-CoV-2. We aim to analyze possible associations between coronavirus disease 2019 (COVID-19) pandemic and spontaneous subarachnoid hemorrhage (SAH), in a comprehensive neurological center. We conducted a retrospective case series of 4 patients infected by COVID-19, who developed spontaneous SAH. Clinical data were extracted from electronic medical records. Between March 24, 2020, and May 22, 2020, 4 cases (3 females; 1 male) of SAH were identified in patients infected with SARS-CoV-2, in a comprehensive neurological center in Brazil. The median age was 55.25 years (range 36 -71). COVID-19-related pneumonia was severe in 3 out of 4 cases, and all patients required critical care support during hospitalization. The patients developed Fisher grade III and IV SAH. Digital subtraction angiography (DSA) was performed in 3 of the 4 patients. However, in only 1 case, an aneurysm was identified. Inflammatory blood tests were elevated in all cases, with an average D-dimer of 2336 μg/L and mean C-reactive protein (CRP) of 3835 mg/dl The outcome was poor in the majority of the patients, with 1 death (25%); 2 (50%) remained severely neurologically affected (mRS:4); and 1 (25%) had slight disability (mRS:2). This study shows a series of 4 rare cases of SHA associated with COVID-19. The possible mechanisms underlying the involvement of SARSCoV-2 and SHA is yet to be fully understood. Therefore, SHA should be included in severe neurological manifestations in patients infected by this virus.

A Fatal Extrapulmonary Manifestation of COVID-19

“…A number of IC manifestations of COVID-19 have been reported, mainly stroke, encephalitis, and encephalopathies [2,3]. Very few IC hemorrhages have been reported, most of which were found to be subarachnoid hemorrhages [4]. This case is of a young man with a fatal IVH without any obvious source of intraparenchymal hemorrhage.…”

“…There has been emerging evidence of COVID-19 being associated with a myriad of intracerebral (IC) pathology such as stroke, encephalitis, and encephalopathy [2,3]. Cezar-Junior et al [4] demonstrated four rare cases of subarachnoid hemorrhage in COVID-19 patients. Intraventricular hemorrhage (IVH) commonly occurs as complication of IC or subarachnoid hemorrhages; primary IVH are a rare occurrence, accounting for about 3.1% of all IC hemorrhages [5].…”

A case-based systematic review on the SARS-COVID-2-associated cerebrovascular diseases and the possible virus routes of entry

“…The remaining 71 articles (127 patients) that satisfied the criteria mentioned above were included in this review. In this review, 80 cases of patients developed IS during COVID-19 infection (Aasfara et al 2021 ; Abdulkadir et al 2020 ; Agarwal et al 2020 ; Al-Mufti et al 2021 ; Al Saiegh et al 2020 ; Appavu et al 2021 ; Ashraf and Sajed 2020 ; Avula et al 2020 ; Bessa et al 2020 ; Bigliardi et al 2020 ; Burkert and Patil 2020 ; Co et al 2020 ; Dakay et al 2020a , b ; de Almeida Lima et al 2020 ; de Lorenzo Alvarez et al 2021 ; Deliwala et al 2020 ; Dumitrascu et al 2020 ; Efendizade et al 2020 ; El Nahas et al 2020 ; Elshereye and Erdinc 2020 ; Eskandarani et al 2021 ; Fu et al 2021 ; Garg et al, 2020 ; Gemcioglu et al 2020 ; Goette et al 2020 ; Goldberg et al 2020 ; Guillan et al 2020 ; Iqbal et al 2021 ; Kwon et al 2020 ; Mahboob et al 2020 ; Mansour et al 2020 ; Mirzaee et al 2020 ; Morassi et al 2020 ; Mowla et al 2020 ; Patel et al 2020a , b ; Patel et al 2020a , b ; Prasad et al 2021 ; Priftis et al 2020 ; Rajdev et al 2020 ; Rascón-Ramírez et al 2020 ; Roy et al 2021 ; Valderrama et al 2020 ; Viguier et al 2020 ; Zhai et al 2020 ), 32 cases developed intracranial hemorrhage (Ahmad et al 2021 ; Al-Mufti et al 2021 ; Al Saiegh et al 2020 ; Carroll and Lewis 2021 ; Cezar-Junior et al 2020 ; Dakay et al 2020a , b ; Dakay et al 2020a , ...…”

Intracerebral Haemorrhage in an Adolescent With COVID-19 With Acute Kidney Injury: Is the Virus to Blame?

“…There are many case reports of intracerebral hemorrhage in adults with COVID 19 but reports is children are lacking. Basirjafari et al reported subarachnoid hemorrhage (SAH) as a severe neurological manifestation associated with pediatric COVID-19 in a 9-year-old child [12].…”