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Intracranial Hemorrhage in COVID-19 Patients
Sanskriti Mishra1, Murray Choueka2, Qiang Wang2
1Department of Neurology, Comprehensive Stroke Center, Maimonides Medical Center, 948 48th St, 2nd Fl, Brooklyn, NY 11219, United States; Department of Neurology & Stroke Center, SUNY Downstate Health Sciences University, Brooklyn, NY, United States.
Insights
COVID-19 patients experiencing acute Intracranial Hemorrhage (ICH) often had pre-existing risk factors and severe pneumonia. A relative surge in ICH occurred during the pandemic
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 has been linked to various neurological complications.
- Intracranial Hemorrhage (ICH) is a serious cerebrovascular event.
- Understanding the interplay between COVID-19 and ICH is crucial for patient management.
Purpose of the Study:
- To characterize the clinical, laboratory, temporal, radiographic, and outcome features of acute Intracranial Hemorrhage (ICH) in patients with COVID-19.
- To investigate the potential association between COVID-19 and ICH incidence during the pandemic.
Main Methods:
- Retrospective, observational case series of patients with ICH and confirmed/suspected COVID-19.
- Analysis of demographic, clinical, laboratory, and imaging data.
- Comparison of ICH rates among all strokes during the pandemic peak versus the previous year.
Main Results:
- Among 324 stroke patients, 65 had non-traumatic ICH; 11 had confirmed or suspected COVID-19.
- Most COVID-19 associated ICH cases (82%) had at least one known ICH risk factor.
- A relative surge in ICH as a percentage of all strokes was observed during the NYC COVID-19 peak (40% in April).
Conclusions:
- COVID-19 associated ICH frequently co-occurs with known ICH risk factors and severe pneumonia.
- A potential increase in ICH incidence relative to other strokes was noted during the early pandemic.
- Vigilance for ICH as a manifestation of COVID-19 is warranted.
Objective:
To describe the clinical, laboratory, temporal, radiographic, and outcome features of acute Intracranial Hemorrhage (ICH) in COVID-19 patients.
Methods:
Retrospective, observational, consecutive case series of patients admitted with ICH to Maimonides Medical Center from March 1 through July 31, 2020, who had confirmed or highly suspected COVID-19. Demographic, clinical, laboratory, imaging, and outcome data were analyzed. ICH rates among all strokes were compared to the same time period in 2019 in two-week time intervals. Correlation of systolic blood pressure variability (SBPV) and neutrophil-to-lymphocyte ratio (NLR) to clinical outcomes were performed.
Results:
Of 324 patients who presented with stroke, 65 (20%) were diagnosed with non-traumatic ICH: 8 had confirmed and 3 had highly suspected COVID-19. Nine (82%) had at least one associated risk factor for ICH. Three ICHs occurred during inpatient anticoagulation. More than half (6) suffered either deep or cerebellar hemorrhages; only 2 were lobar hemorrhages. Two of 8 patients with severe pneumonia survived. During the NYC COVID-19 peak period in April, ICH comprised the highest percentage of all strokes (40%), and then steadily decreased week-after-week (p = 0.02). SBPV and NLR were moderately and weakly positively correlated to discharge modified Rankin Scale, respectively.
Conclusions:
COVID-19 associated ICH is often associated with at least one known ICH risk factor and severe pneumonia. There was a suggestive relative surge in ICH among all stroke types during the first peak of the NYC pandemic. It is important to be vigilant of ICH as a possible and important manifestation of COVID-19.
