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Intracranial hemorrhage in critically ill patients hospitalized for COVID-19

Islam Fayed1, Gnel Pivazyan1, Anthony G Conte1

  • 1MedStar Georgetown University Hospital, Department of Neurosurgery, 3800 Reservoir Road NW, 7PHC, Washington, DC 20007, USA; MedStar Washington Hospital Center, Department of Neurosurgery, 110 Irving Street NW, Washington, DC 20010, USA.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|November 23, 2020
PubMed

Insights

Three critically ill COVID-19 patients developed intracranial hemorrhages during hospitalization. This suggests a potential link between SARS-CoV-2 infection and bleeding in the brain, especially in ventilated patients.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Vascular Biology

Background:

  • COVID-19, caused by SARS-CoV-2, can lead to severe illness requiring intensive care.
  • Intracranial hemorrhage (ICH) is a serious complication with various underlying causes.
  • The neurological manifestations of COVID-19 are increasingly recognized.

Observation:

  • Three critically ill patients with confirmed SARS-CoV-2 infection developed spontaneous intracranial hemorrhages.
  • These hemorrhages included intracerebral and subarachnoid types.
  • Patients required intubation and ventilatory support during protracted hospitalizations.

Findings:

  • The intracranial hemorrhages occurred in the context of anticoagulation and coagulopathy.
  • A potential mechanism involves SARS-CoV-2 tropism for endothelial angiotensin-converting enzyme (ACE) II receptors in cerebral vasculature.
  • This may contribute to bleeding events in severe COVID-19.

Implications:

  • Heightened vigilance for intracerebral hemorrhage is recommended in COVID-19 patients.
  • Consider neuroimaging for patients with prolonged ventilation and depressed neurologic status.
  • Understanding the vascular effects of SARS-CoV-2 is crucial for patient management.

Keywords:
COVID-19CoagulopathyEndothelial injuryIntracerebral hemorrhageSubarachnoid hemorrhage

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