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Intracerebral hemorrhage in COVID-19: A narrative review
Nikolaos Panagiotis Margos1, Andreas Stylianos Meintanopoulos1, Dimitrios Filioglou1
1School of Medicine, University of Patras, Institutional Address: University Campus, 26504 Rio, Greece.
Insights
This review examines intracerebral hemorrhage (ICH) in patients with Coronavirus Disease 19 (COVID-19). While SARS-CoV-2 may cause ICH, risk factors like anticoagulation and ICU admission are also implicated, with high mortality observed.
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus Disease 19 (COVID-19) is primarily a respiratory illness, but neurological complications, including intracerebral hemorrhage (ICH), are increasingly recognized.
- Understanding the link between COVID-19 and ICH is crucial for managing severely ill patients.
Purpose of the Study:
- To review the etiology, clinical presentation, location, and outcomes of patients experiencing intracerebral hemorrhage (ICH) in the context of COVID-19.
Main Methods:
- A systematic review of 36 studies reporting on patients with COVID-19 and intracranial hemorrhage.
- Analysis of 217 reported cases, with a focus on 188 cases of intracerebral hemorrhage (ICH).
Main Results:
- A low incidence of ICH (0.25%) was observed in hospitalized COVID-19 patients.
- The median age of patients with ICH was 58 years, with 64% being male.
- Common factors included prior anticoagulation (75%), hypertension (52%), and ICU admission (61%).
- Mortality due to ICH in COVID-19 patients was high, at 52.7%.
Conclusions:
- SARS-CoV-2 infection may directly contribute to ICH, but traditional risk factors like anticoagulation and critical illness also play significant roles.
- Physicians should maintain a high index of suspicion for ICH in severe COVID-19 patients, particularly those on anticoagulants and in the ICU.
- Further research is needed to elucidate the direct causal relationship between COVID-19 and ICH versus ICH as a complication of severe illness.
Abstract:
Coronavirus Disease 19 (COVID-19) pandemic affects the worldwide healthcare system and our understanding of this disease grows rapidly. Although COVID-19 is a mainly respiratory disease, neurological manifestations are not uncommon. The aim of this review is to report on the etiology, clinical profile, location, and outcome of patients with intracerebral hemorrhage (ICH) and COVID-19. This review includes 36 studies examining ICH in the clinical presentation of COVID-19. Overall, 217 cases with intracranial hemorrhage, of which 188 ICHs, were reported. Generally, a low incidence of both primary and secondary ICH was found in 8 studies [106 (0.25%) out of 43,137 hospitalized patients with COVID-19]. Available data showed a median age of 58 years (range: 52-68) and male sex 64%, regarding 36 and 102 patients respectively. Furthermore, 75% of the patients were on prior anticoagulation treatment, 52% had a history of arterial hypertension, and 61% were admitted in intensive care unit. Location of ICH in deep structures/basal ganglia was ascertained in only 7 cases making arterial hypertension an improbable etiopathogenetic mechanism. Mortality was calculated at 52.7%. Disease related pathophysiologic mechanisms support the hypothesis that SARS-CoV2 can cause ICH, however typical ICH risk factors such as anticoagulation treatment, or admission to ICU should also be considered as probable causes. Physicians should strongly suspect the possibility of ICH in individuals with severe COVID-19 admitted to ICU and treated with anticoagulants. It is not clear whether ICH is related directly to COVID-19 or reflects expected comorbidity and/or complications observed in severely ill patients.
