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Hemorrhagic stroke in setting of severe COVID-19 infection requiring Extracorporeal Membrane Oxygenation (ECMO)
Muhammad J Zahid1, Anam Baig2, Nestor Galvez-Jimenez3
1PGY-2, Neurology, Cleveland Clinic Florida, Department of Neurology, 2950 Cleveland Clinic Blvd., Weston, FL 33331.
Insights
Patients with COVID-19 (Coronavirus Disease 2019) may face a higher risk of hemorrhagic stroke due to COVID-19-related vasculopathy and extracorporeal membrane oxygenation (ECMO) complications. This case highlights the cerebrovascular risks in critically ill patients.
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 (Coronavirus Disease 2019) is a systemic illness affecting multiple organs beyond the respiratory system.
- Neurological complications, including stroke, are increasingly recognized in COVID-19 patients.
- Critically ill patients requiring extracorporeal membrane oxygenation (ECMO) are particularly vulnerable to hemorrhagic stroke.
Observation:
- A 38-year-old male presented with severe respiratory failure due to COVID-19, necessitating ECMO support.
- The patient subsequently developed a left temporal intraparenchymal hemorrhage.
- Despite the intracranial hemorrhage, the patient's overall clinical condition improved.
Findings:
- COVID-19 infection may potentiate the risk of hemorrhagic stroke in patients on ECMO.
- A postulated COVID-19-mediated vasculopathy could contribute to cerebrovascular complications.
- Intracranial hemorrhage is a known but potentially heightened risk in this patient population.
Implications:
- Clinicians should maintain a high index of suspicion for cerebrovascular events in COVID-19 patients, especially those on ECMO.
- Understanding the interplay between COVID-19, vasculopathy, and ECMO is crucial for managing critically ill patients.
- Further research is warranted to elucidate the mechanisms of COVID-19-associated vasculopathy and its impact on stroke risk.
Objective:
To highlight the increased risk of hemorrhagic stroke secondary to postulated COVID-19 mediated vasculopathy with concomitant ECMO related bleeding complications.
Background:
COVID-19 has shown to be a systemic illness, not localized to the respiratory tract and lung parenchyma. Stroke is a common neurological complication. In particular, critically ill patients on ECMO are likely at higher risk of developing hemorrhagic stroke.
Case Presentation:
38-year-old man presented with fever, cough, and shortness of breath. Due to severe respiratory failure, he required ECMO support. Subsequently, he was found to have left temporal intraparenchymal hemorrhage. Overall, his clinical course improved, and he was discharged with minimal neurological deficits.
Conclusion:
Although intracranial hemorrhage is a known complication of ECMO, patients with COVID-19 infection may be at a higher risk of cerebrovascular complications due to vasculopathy.
