Catastrophic Intracranial Hemorrhage in Two Critically Ill Patients with COVID-19

Carroll, Elizabeth; Lewis, Ariane

doi:10.1007/s12028-020-00993-5

Cited by 34 publications

(36 citation statements)

References 7 publications

(14 reference statements)

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“…The remaining 80 articles (275 patients), which satisfied the abovementioned criteria, were included in this review. We found 226 cases of patients who developed IS during COVID-19 infection ( 16 , 18 , 20 , 22 – 29 , 63 – 106 ), 35 cases of intracranial bleeding ( 25 , 72 , 74 , 100 – 104 ), and 14 cases of CVST ( 22 , 31 , 105 – 113 ). Individual case descriptions are available in the Supplementary Material (S1 , S2 , S3) .…”

Section: Resultsmentioning

confidence: 99%

“…Acute intracranial bleeding was reported in 35 patients with COVID-19 in the literature ( Table 2, Supplementary Table 2): 24 patients (68.57%) had intracerebral hemorrhage (ICH), 4 patients (11.43%) had non-traumatic subarachnoid hemorrhage (SAH), and the remaining 7 patients (20%) had the simultaneous presence of SAH and ICH. The mean age of the 35 patients with intracranial bleedings was 59.89 ± 11.91 years and 67.4% were males (16,25,28,64,71,73,(107)(108)(109)(110)(111)(112)(113)(114)(115)(116)(117)(118)(119)(120)(121). Two of the 11 patients with non-traumatic SAH (regardless of the presence of ICH) were found to have a ruptured dissecting aneurysm (one in the posterior inferior cerebellar artery; one in the pericallosal artery).…”

Section: Intracranial Bleedingmentioning

confidence: 99%

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COVID-19 and Cerebrovascular Diseases: A Systematic Review and Perspectives for Stroke Management

et al. 2020

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Importance: Reported cerebrovascular events in patients with COVID-19 are mainly ischemic, but hemorrhagic strokes and cerebral venous sinus thrombosis (CSVT), especially in critically ill patients, have also been described. To date, it is still not clear whether cerebrovascular manifestations are caused by direct viral action or indirect action mediated by inflammatory hyperactivation, and in some cases, the association may be casual rather than causal. Objective: To conduct a systematic review on the cerebrovascular events in COVID-19 infection. Evidence review: A comprehensive literature search on PubMed was performed including articles published from January 1, 2020, to July 23, 2020, using a suitable keyword strategy. Additional sources were added by the authors by reviewing related references. The systematic review was conducted in accordance with the PRISMA guidelines. Only articles reporting individual data on stroke mechanism and etiology, sex, age, past cardiovascular risk factors, COVID symptoms, admission NIHSS, D-dimer levels, and acute stroke treatment were selected for the review. Articles that did not report the clinical description of the cases were excluded. A descriptive statistical analysis of the data collected was performed. Finding: From a total of 1,210 articles published from January 1, 2020, to July 23, 2020, 80 articles (275 patients), which satisfied the abovementioned criteria, were included in this review. A total of 226 cases of ischemic stroke (IS), 35 cases of intracranial bleeding, and 14 cases of CVST were found. Among patients with IS, the mean age was 64.16 ±14.73 years (range 27-92 years) and 53.5% were male. The mean NIHSS score reported at the onset of stroke was 15.23 ±9.72 (range 0-40). Primary endovascular thrombectomy (EVT) was performed in 24/168 patients (14.29%), intravenous thrombolysis (IVT) was performed in 17/168 patients (10.12%), and combined IVT+EVT was performed in 11/168 patients (6.55%). According to the reported presence of large vessel occlusion (LVO) (105 patients), 31 patients (29.52%) underwent primary EVT or bridging. Acute intracranial bleeding was reported in 35 patients: 24 patients (68.57%) had intracerebral hemorrhage (ICH), 4 patients (11.43%) Fraiman et al. COVID-19 and Cerebrovascular Diseases had non-traumatic subarachnoid hemorrhage (SAH), and the remaining 7 patients (20%) had the simultaneous presence of SAH and ICH. Fourteen cases of CVST were reported in the literature (50% males), mean age 42.8 years ±15.47 (range 23-72). Treatment was reported only in nine patients; seven were treated with anticoagulant therapy; one with acetazolamide, and one underwent venous mechanical thrombectomy. Conclusion: Cerebrovascular events are relatively common findings in COVID-19 infection, and they could have a multifactorial etiology. More accurate and prospective data are needed to better understand the impact of cerebrovascular events in COVID-19 infection.

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Section: Resultsmentioning

confidence: 99%

Section: Intracranial Bleedingmentioning

confidence: 99%

COVID-19 and Cerebrovascular Diseases: A Systematic Review and Perspectives for Stroke Management

et al. 2020

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“…19 Articles [39], [57], [58], [60], [63], [75] [86]), [92], [98], [99], [100], [101], [106], [107], [108], [109], [110], [111], [112 [101], [102], [114], [115], [116], [117], [118], [192] Dixon L et al [149] reported ANE in a 59 Y/O F with history of aplastic anemia who died despite steroid therapy.…”

mentioning

confidence: 99%

Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic

Dorche

Huot

Osherov

et al. 2020

Journal of the Neurological Sciences

183

182

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Coronavirus disease-19 (COVID-19) pandemic continues to grow all over the world. Several studies have been performed, focusing on understanding the acute respiratory syndrome and treatment strategies. However, there is growing evidence indicating neurological manifestations occur in patients with COVID-19. Similarly, the other coronaviruses (CoV) epidemics; severe acute respiratory syndrome (SARS-CoV-1) and Middle East respiratory syndrome (MERS-CoV) have been associated with neurological complications. Methods: This systematic review serves to summarize available information regarding the potential effects of different types of CoV on the nervous system and describes the range of clinical neurological complications that have been reported thus far in COVID-19. Results: Two hundred and twenty-five studies on CoV infections associated neurological manifestations in human were reviewed. Of those, 208 articles were pertinent to COVID-19. The most common neurological complaints in COVID-19 were anosmia, ageusia, and headache, but more serious complications, such as stroke, impairment of consciousness, seizures, and encephalopathy, have also been reported. Conclusion: There are several similarities between neurological complications after SARS-CoV-1, MERS-CoV and COVID-19, however, the scope of the epidemics and number of patients are very different. Reports on the neurological complications after and during COVID-19 are growing on a daily basis. Accordingly, comprehensive knowledge of these complications will help health care providers to be attentive to these complications and diagnose and treat them timely.

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“…So far, only case reports of devastating intracerebral hemorrhages have been published. (10,11) We can only speculate why the rate of intracerebral hemorrhages is so high in the ARDS collective. For SARS-CoV2, neuroinvasion and neurotropism have been reported and the Coronavirus was isolated from cerebrospinal uid and brain tissue.…”

Section: Intracerebral Hemorrhages and Ardsmentioning

confidence: 99%

“…(9) By now, three cases have been reported with massive intracerebral hemorrhage. (10,11) During the treatment of our cohort of critical ill COVID-19 patients, three fatal intracerebral hemorrhages occurred. We therefore raised the question if intracerebral hemorrhage is more common in critically ill COVID-19 patients with respiratory failure compared to the general population of patients with acute respiratory distress syndrome (ARDS).…”

Section: Introductionmentioning

confidence: 97%

Intracerebral hemorrhage in COVID-19 patients with pulmonary failure – a propensity score matched registry study

Lang

Dettinger

Berchtold‐Herz

et al. 2020

Preprint

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Background: Hypercoagulopathy in coronavirus disease 2019 (COVID-19) causing deep vein thrombosis and pulmonary artery embolism necessitate systemic anticoagulation. Case reports of intracerebral hemorrhages in ventilated COVID-19 patients warrant precaution. It is unclear however, if COVID-19 patients with acute respiratory distress syndrome (ARDS) with and without extracorporeal membrane oxygenation therapy (ECMO) have more intracerebral hemorrhages (ICH) compared to other ARDS patients.Methods: We conducted a retrospective observational single center study enrolling all patients with ARDS from 01/2018-05/2020. Patients with ARDS positive for SARS-CoV2 PCR were allocated to the COVID-19 group. Propensity score matching was performed for age, ECMO and risk of bleeding according to HAS-BLED score.Results: A total of 163, mostly severe ARDS patients were identified, 116 (71.2%) without COVID-19 and 47 (28.8%) positive for SARS-CoV-2. The two groups were comparable concerning the main confounders of ICH including age, HAS-BLED score, need for ECMO-therapy as well as anticoagulation levels reported. In 63/163 cases (38.7%), veno-venous ECMO therapy was required and ICU survival was 52.8%. Although HAS-BLED-score on admission was generally low (1.6±1.3), intracerebral hemorrhage was detected in 22 patients (13.5%) with no statistical difference between the groups (11.2 vs. 19.1% with and without SARS-CoV-2, respectively, p=0.21). Propensity score matching confirmed similar intracerebral bleeding rates in both groups (12.8 vs. 19.1% with and without SARS-CoV-2, respectively, p=0.57). Conclusions: Intracerebral hemorrhage was detectable in every tenth patient with ARDS. We found no statistically significant increased bleeding rate in patients with ARDS due to COVID-19 compared to other causes of ARDS.

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Catastrophic Intracranial Hemorrhage in Two Critically Ill Patients with COVID-19

Cited by 34 publications

References 7 publications

COVID-19 and Cerebrovascular Diseases: A Systematic Review and Perspectives for Stroke Management

COVID-19 and Cerebrovascular Diseases: A Systematic Review and Perspectives for Stroke Management

Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic

Intracerebral hemorrhage in COVID-19 patients with pulmonary failure – a propensity score matched registry study

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