Clinical and Imaging Characteristics in Patients with SARS-CoV-2 Infection and Acute Intracranial Hemorrhage

Abstract

Background and Purpose: Intracranial hemorrhage has been observed in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (COVID-19), but the clinical, imaging, and pathophysiological features of intracranial bleeding during COVID-19 infection remain poorly characterized. This study describes clinical and imaging characteristics of patients with COVID-19 infection who presented with intracranial bleeding in a European multicenter cohort. Methods: This is a multicenter retrospective, observational case series including 18 consecutive patients with COVID-19 infection and intracranial hemorrhage. Data were collected from February to May 2020 at five designated European special care centers for COVID-19. The diagnosis of COVID-19 was based on laboratory-confirmed diagnosis of SARS-CoV-2. Intracranial bleeding was diagnosed on computed tomography (CT) of the brain within one month of the date of COVID-19 diagnosis. The clinical, laboratory, radiologic, and pathologic findings, therapy and outcomes in COVID-19 patients presenting with intracranial bleeding were analyzed. Results: Eighteen patients had evidence of acute intracranial bleeding within 11 days (IQR 9–29) of admission. Six patients had parenchymal hemorrhage (33.3%), 11 had subarachnoid hemorrhage (SAH) (61.1%), and one patient had subdural hemorrhage (5.6%). Three patients presented with intraventricular hemorrhage (IVH) (16.7%). Conclusion: This study represents the largest case series of patients with intracranial hemorrhage diagnosed with COVID-19 based on key European countries with geospatial hotspots of SARS-CoV-2. Isolated SAH along the convexity may be a predominant bleeding manifestation and may occur in a late temporal course of severe COVID-19.

Characteristics of intracerebral haemorrhage associated with COVID-19: a systematic review and pooled analysis of individual patient and aggregate data

“…The majority of patients with COVID-19-associated ICH (77%) presented with COVID-19 symptoms prior to haemorrhagic stroke onset, with a median delay of 15 days in keeping with previous studies [ 37 , 38 ], also suggesting that a delayed haemorrhagic vasculopathy could be a contributory factor.…”

COVID-19 infection produces subarachnoid hemorrhage; acting now to understand its cause: A short communication

“…In their series of 12 patients, 10 patients had an ischemic stroke, of which 1 suffered hemorrhagic transformation and only two had intracerebral hemorrhage [ 10 ]. Recently, a European multicenter study, eighteen COVID 19 patients with intracranial hemorrhage were reported [ 11 ]. Of these patients, 11(61.1 %) has had SAH [ 11 ], but secondary SAH was seen in only one patient.…”

“…Recently, a European multicenter study, eighteen COVID 19 patients with intracranial hemorrhage were reported [ 11 ]. Of these patients, 11(61.1 %) has had SAH [ 11 ], but secondary SAH was seen in only one patient. In this European multicenter study case series, no aneurysm was found in DSA.…”

“…In this European multicenter study case series, no aneurysm was found in DSA. The major pathologic state of necrotizing vasculitis is typically associated with parenchymal hemorrhage [ 11 ]. In our case series, cranial and chest CTs were obtained.…”

“…SAH may be depended on anticoagulation therapy, two patients of the present study had not used anticoagulation therapy, their platelet count, and the prothrombin time was normal. Another problem is that ECMO and ventilation may lead to an increased incidence of intracranial hemorrhage [ 11 ], likely SAH. However, in four of our case series, SAH had been occurred, before ECMO and ventilation therapy has been given.…”