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Intracranial Hemorrhage in a Patient With COVID-19: Possible Explanations and Considerations

Bhanu Gogia1, Xiang Fang1, Prashant Rai1

  • 1Neurology, University of Texas Medical Branch, Galveston, USA.

Cureus
|September 5, 2020
PubMed

Insights

COVID-19 can cause neurological issues, including dangerous bleeding in the brain. A patient on blood thinners developed a fatal hemorrhage, raising concerns about anticoagulation safety in COVID-19 patients.

Area of Science:

  • Neurology
  • Hematology
  • Infectious Diseases

Background:

  • COVID-19 is associated with various neurological complications.
  • Intracranial hemorrhage is a rare but severe manifestation.

Observation:

  • A 75-year-old COVID-19 patient presented with elevated D-dimer and coagulopathy.
  • The patient was treated with aspirin, clopidogrel, and therapeutic enoxaparin.
  • Neurological deterioration occurred, confirmed by CT scan revealing extensive intracranial hemorrhage.

Findings:

  • The patient developed a fatal acute subdural hematoma, intraparenchymal hemorrhage, and subarachnoid hemorrhage.
  • Contributing factors included hypertension, triple antiplatelet/anticoagulant therapy, and COVID-19-related coagulopathy.

Implications:

  • This case highlights the potential risk of life-threatening intracranial hemorrhage in COVID-19 patients receiving therapeutic anticoagulation.
  • Caution is advised when initiating aggressive anticoagulation in COVID-19 patients, especially those with pre-existing risk factors.

Keywords:
covid-19 and ichcovid-19 neurological outcomesfatal outcomes covid-19intracranial hemorrhage and sars-cov-2stroke and covid-19

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