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Isolated intracranial hypertension associated with COVID-19
Marcus Tulius T Silva1,2, Marco A Lima1,3, Guilherme Torezani4
1Evandro Chagas National Institute of Infectious Diseases (INI), FIOCRUZ, Brazilian Ministry of Health, Brazil.
Insights
Headache in COVID-19 patients can indicate intracranial hypertension without brain inflammation. Further research is needed to understand this neurological complication and its causes.
Area of Science:
- Neurology
- Infectious Diseases
- Neuroscience
Background:
- Headache is a common symptom in COVID-19 patients, but detailed characteristics are often lacking.
- This study aimed to describe headache features and cerebrospinal fluid (CSF) profiles in COVID-19 patients, focusing on intracranial hypertension.
Observation:
- Thirteen of 56 COVID-19 patients (23.2%) presented with new, persistent headaches requiring CSF analysis.
- Headaches were typically throbbing, holocranial, or bilateral.
- CSF analysis and SARS-CoV-2 RT-qPCR were negative in all patients.
Findings:
- Elevated CSF opening pressure (>200 mmH2O) was observed in 11 patients, with six exceeding 250 mmH2O.
- A significant proportion of COVID-19 headaches were linked to intracranial hypertension without meningitic or encephalitic signs.
- Most patients experienced headache improvement, though some had persistent daily headaches.
Implications:
- COVID-19-associated headaches may be linked to intracranial hypertension, even without overt central nervous system infection.
- Potential mechanisms, such as COVID-19-related coagulopathy, require further investigation.
- Post-mortem studies of CSF production and absorption sites are recommended to elucidate the pathophysiology.
Background:
Headache is a frequent complaint in COVID-19 patients. However, no detailed information on headache characteristics is provided in these reports. Our objective is to describe the characteristics of headache and the cerebrospinal fluid (CSF) profile in COVID-19 patients, highlighting the cases of isolated intracranial hypertension.
Methods:
In this cross-sectional study, we selected COVID-19 patients who underwent lumbar puncture due to neurological complaints from April to May 2020. We reviewed clinical, imaging, and laboratory data of patients with refractory headache in the absence of other encephalitic or meningitic features. CSF opening pressures higher than 250 mmH2O were considered elevated, and from 200 to 250 mmH2O equivocal.
Results:
Fifty-six COVID-19 patients underwent lumbar puncture for different neurological conditions. A new, persistent headache that prompted a CSF analysis was diagnosed in 13 (23.2%). The pain was throbbing, holocranial or bilateral in the majority of patients. All patients had normal CSF analysis and RT-qPCR for SARS-CoV-2 was negative in all samples. Opening pressure >200 mmH2O was present in 11 patients and, in six of these, > 250 mmH2O. 6/13 patients had complete improvement of the pain, five had partial improvement, and two were left with a daily persistent headache.
Conclusions:
In a significant proportion of COVID-19 patients, headache was associated to intracranial hypertension in the absence of meningitic or encephalitic features. Coagulopathy associated with COVID-19 could be an explanation, but further studies including post-mortem analysis of areas of production and CSF absorption (choroid plexuses and arachnoid granulations) are necessary to clarify this issue.
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