The relationship between COVID-19 infection and intracranial hemorrhage: A systematic review

Daly, Samuel R; Nguyen, Anthony; Zhang, Yilu; Feng, Dongxia; Huang, Jason H.

doi:10.1016/j.hest.2021.11.003

Cited by 31 publications

(25 citation statements)

References 102 publications

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“…The 1-month incidence of intracerebral hemorrhage among COVID-19 inpatients was 0.1%, similar to previously published studies ( 46 ). The frequency was 4.8 times higher in COVID-19 positive compared to negative outpatients.…”

Section: Discussionsupporting

confidence: 90%

“…In two recent studies, 76% (25 of 33) and 60% (6 out 10) of patients developed intracerebral hemorrhage after low- or high-dose anticoagulation therapy ( 47 , 48 ). Besides anticoagulation, a systematic review of 94 studies found that older age, mechanical ventilation and extracorporeal membrane oxygenation also increased the risk of intracranial hemorrhage in COVID-19 patients ( 46 ). In our study, the risk of intracerebral hemorrhage remained elevated after removal of patients who received intravenous thrombolysis, indicating an independent COVID-19 related risk.…”

Section: Discussionmentioning

confidence: 99%

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Frequency of Neurological Diseases After COVID-19, Influenza A/B and Bacterial Pneumonia

et al. 2022

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IntroductionCOVID-19 might affect the incidence of specific neurological diseases, but it is unknown if this differs from the risk following other infections. Here, we characterized the frequency of neurodegenerative, cerebrovascular, and immune-mediated neurological diseases after COVID-19 compared to individuals without COVID-19 and those with other respiratory tract infections.MethodsThis population-based cohort study utilized electronic health records covering ~50% of Denmark's population (n = 2,972,192). Between 02/2020 and 11/2021, we included individuals tested for COVID-19 or diagnosed with community-acquired bacterial pneumonia in hospital-based facilities. Additionally, we included individuals tested for influenza in the corresponding pre-pandemic period between 02/ 2018 and 11/2019. We stratified cohorts for in- and outpatient status, age, sex, and comorbidities.ResultsIn total, 919,731 individuals were tested for COVID-19, of whom 43,375 tested positive (35,362 outpatients, 8,013 inpatients). Compared to COVID-negative outpatients, COVID-19 positive outpatients had an increased RR of Alzheimer's disease (RR = 3.5; 95%CI: 2.2–5.5) and Parkinson's disease (RR = 2.6; 95%CI: 1.7–4.0), ischemic stroke (RR = 2.7; 95%CI: 2.3–3.2) and intracerebral hemorrhage (RR = 4.8; 95%CI: 1.8–12.9). However, when comparing to other respiratory tract infections, only the RR for ischemic stroke was increased among inpatients with COVID-19 when comparing to inpatients with influenza (RR = 1.7; 95%CI: 1.2–2.4) and only for those >80 years of age when comparing to inpatients with bacterial pneumonia (RR = 2.7; 95%CI: 1.2–6.2). Frequencies of multiple sclerosis, myasthenia gravis, Guillain-Barré syndrome and narcolepsy did not differ after COVID-19, influenza and bacterial pneumonia.ConclusionThe risk of neurodegenerative and cerebrovascular, but not neuroimmune, disorders was increased among COVID-19 positive outpatients compared to COVID-negative outpatients. However, except for ischemic stroke, most neurological disorders were not more frequent after COVID-19 than after other respiratory infections.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Frequency of Neurological Diseases After COVID-19, Influenza A/B and Bacterial Pneumonia

et al. 2022

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“…There have been many published datasets that further support this risk/benefit analysis by showing that the risk of developing CVST during a COVID-19 infection is much higher than developing CVST following the Ad26.COV2.S vaccine [18,[26][27][28][29][30]. As vaccine boosters are approved and widely administered, it is important to keep this rare side effect in mind when evaluating patients in the weeks after their vaccine and to consider neurosurgical decompression for life-threatening IPH related to VITT-induced CVST.…”

Section: Discussionmentioning

confidence: 86%

Ad26.COV2.S Vaccine-Induced Thrombocytopenia Leading to Dural Sinus Thrombosis and Intracranial Hemorrhage Requiring Hemicraniectomy: A Case Report and Systematic Review

Daly¹,

Nguyen²,

Soto³

et al. 2022

Cureus

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The coronavirus disease 2019 (COVID-19) pandemic has claimed nearly 5.5 million lives worldwide. Adenovirus-based vaccines are safe and effective, but they are rarely associated with vaccine-induced thrombosis and thrombocytopenia (VITT) as well as cerebral venous sinus thrombosis (CVST). We conducted a systematic literature search of intracerebral hemorrhage (ICH) secondary to CVST associated with VITT from the Ad26.COV2.S vaccine, and we present the first case of this pathology in the reviewed literature of a patient who required neurosurgical decompression. The systematic literature review was completed on December 19, 2021, by searching PubMed and Ovid for articles with primary data on CVST associated with VITT following the Ad26.COV2.S vaccine. We also specifically searched for cases that required neurosurgical intervention. Articles were independently screened by two authors, and both secondary and tertiary searches were done as well. Descriptive statistics were collected and presented in table form. Nine studies were identified that met inclusion criteria. There were no cases identified of patients who underwent neurosurgical decompression after developing this pathology. We thus present the first case in the reviewed literature of a patient who developed ICH after receiving the Ad26.COV2.S vaccine and underwent decompressive hemicraniectomy. Despite severe thrombocytopenia and prolonged intensive care, the patient was discharged to neurorehabilitation. There is a much greater risk of CVST and ICH during COVID-19 infections than from the vaccines. However, as booster vaccines are approved and widely distributed, it is critical to make prompt, accurate diagnoses of this vaccine-related complication and consider neurosurgical decompression.

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“…Though the mechanisms just described may inherently contribute to the development of ICH in COVID-19 patients, there are multiple external factors that many of these patients may also have concerning their critical illness and its treatment, which may concurrently elevate the risk of hemorrhage. For example, both therapeutic anticoagulation and mechanical intubation are risk factors for the development of ICH in COVID-19 infection [49,55,56]. Such treatment modalities are common in COVID-19 infection, particularly when the severity of illness warrants ICU admission, which poses a challenge to treating providers of balancing the risks and benefits of their approaches.…”

Section: Mechanisms Of Intracerebral Hemorrhage In Covid-19 Patientsmentioning

confidence: 99%

Pathomechanisms and Treatment Implications for Stroke in COVID-19: A Review of the Literature

Stamm

Huang

Royan

et al. 2022

Life

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Stroke in patients with COVID-19 has received increasing attention throughout the global COVID-19 pandemic, perhaps due to the substantial disability and mortality that can result when the two conditions co-occur. We reviewed the existing literature and found that the proposed pathomechanism underlying COVID-19-associated ischemic stroke is broadly divided into the following three categories: vasculitis, endothelialitis, and endothelial dysfunction; hypercoagulable state; and cardioembolism secondary to cardiac dysfunction. There has been substantial debate as to whether there is a causal link between stroke and COVID-19. However, the distinct phenotype of COVID-19-associated strokes, with multivessel territory infarcts, higher proportion of large vessel occlusions, and cryptogenic stroke mechanism, that emerged in pooled analytic comparisons with non-COVID-19 strokes is compelling. Further, in this article, we review the various treatment approaches that have emerged as they relate to the proposed pathomechanisms. Finally, we briefly cover the logistical challenges, such as delays in treatment, faced by providers and health systems; the innovative approaches utilized, including the role of tele-stroke; and the future directions in COVID-19-associated stroke research and healthcare delivery.

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The relationship between COVID-19 infection and intracranial hemorrhage: A systematic review

Cited by 31 publications

References 102 publications

Frequency of Neurological Diseases After COVID-19, Influenza A/B and Bacterial Pneumonia

Frequency of Neurological Diseases After COVID-19, Influenza A/B and Bacterial Pneumonia

Ad26.COV2.S Vaccine-Induced Thrombocytopenia Leading to Dural Sinus Thrombosis and Intracranial Hemorrhage Requiring Hemicraniectomy: A Case Report and Systematic Review

Pathomechanisms and Treatment Implications for Stroke in COVID-19: A Review of the Literature

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