COVID-19 and intracerebral haemorrhage: causative or coincidental?

Sharifi-Razavi, Athena; Karimi, Narges; Rouhani, Nima

doi:10.1016/j.nmni.2020.100669

Cited by 296 publications

(320 citation statements)

References 6 publications

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“…Activation of the coagulation cascade leading to disseminated intravascular coagulation can signi cantly contribute to the multiorgan involvement in patients with COVID-19, resulting in acute ischemic stroke, cerebral venous sinus thrombosis or intracerebral hemorrhage [8,40,41]. Moreover, the adhesion of SARS-CoV-2 to ACE2 receptors gains particular importance in the cases of intracerebral hemorrhage due to the inactivation of the receptor and subsequent dysfunction in blood pressure regulation [8,11,15,20,40]. It is also possible that some cases of ischemic stroke in COVID-19 patients have a cardio-embolic source from virus-related cardiac injury [11].…”

Section: Discussionmentioning

confidence: 99%

“…2). Thirty-one patients experienced a cerebrovascular complication, with 27 ischemic strokes [11,[19][20][21][22][23], 3 hemorrhagic strokes [11,15,23] and 1 cerebral venous sinus thrombosis [11]. There were 15 patients with GBS [13,14,[24][25][26][27][28][29][30] or its variants, 6 reported as encephalitis [12,18,[31][32][33], one with seizures [34], one with acute hemorrhagic necrotizing encephalopathy [16] one reported as transverse myelitis [35], and one reported as ADEM [36].…”

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confidence: 99%

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Neurological Complications of COVID-19: A Systematic Review of Literature

Sriwastava

Srivastava

Kataria

et al. 2020

Preprint

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Abstract Background: To study the nature and frequency of occurrence of “significant” neurological complications in coronavirus disease-2019 (COVID-19) via a systematic review of the literature.Methods: We screened all articles resulting from a search of PubMed, Cochrane, Google Scholar and Scopus, using the keywords "COVID-19 and CNS", "SARS-CoV-2 and CNS”, “COVID-19 and neurological manifestation”, “SARS2 and neurological manifestation” and “COVID-19 and Brain” looking for reports of significant neurological manifestations that would potentially have an impact on the outcome.Results: Twenty-six articles met the inclusion criteria. The significant neurological diagnoses reported were stroke, Guillain Barre Syndrome (GBS) and its variants, encephalitis, seizures, acute hemorrhagic necrotizing encephalopathy, acute disseminated encephalomyelitis (ADEM) and transverse myelitis. Although stroke, predominantly ischemic, was observed in ~ 6% of COVID-19 patients from Wuhan, China, mortality in this cohort was 38%. Of the 24 pooled patients with reports of etiology, 17 had large vessel occlusions. GBS occurred in 5/1200 (0.4%) of the COVID-19 cohort from Italy. One of the six reported encephalitis cases, the ADEM case and the report of transverse myelitis do not have data for conclusive diagnosis.Conclusion: The most frequent significant neurological association with COVID-19 is stroke, predominantly ischemic. In a cohort from Wuhan, China, this was as frequent as ~ 6%, with a 38% mortality. Most common reported etiology is large vessel occlusion. Other reported significant neurological complications are GBS/variants, encephalitis, seizures and acute hemorrhagic necrotizing encephalopathy. The reports of ADEM and transverse myelitis lacked diagnostically conclusive data.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Neurological Complications of COVID-19: A Systematic Review of Literature

Sriwastava

Srivastava

Kataria

et al. 2020

Preprint

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“…ACE2 is a multispecific enzyme. Although ACE2, located in the surface of lung alveolar epithelial cells among others (Hamming et al 2004;Zou et al 2020) is a receptor for SARS coronaviruses including SARS-CoV-2 (Yan et al 2020;Shang et al 2020), it is also a demonstrated protective factor for SARS in the lung (Jia 2016). ACE2 cleaves Angiotensin II into Ang (1-7), part of the ACE2/Angiotensin (1-7)/Mas axis, a proposed protective mechanism balancing RAS overstimulation, and this system is stimulated by ARBs (Ren et al 2019).…”

Section: Ace2 As a Therapeutic Target In Fighting Sars-cov-2 Infectionmentioning

confidence: 99%

COVID-19, Angiotensin Receptor Blockers, and the Brain

Saavedra

2020

Cell Mol Neurobiol

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“…(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: 96%

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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COVID-19 and intracerebral haemorrhage: causative or coincidental?

Cited by 296 publications

References 6 publications

Neurological Complications of COVID-19: A Systematic Review of Literature

Neurological Complications of COVID-19: A Systematic Review of Literature

COVID-19, Angiotensin Receptor Blockers, and the Brain

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

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