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Published on: February 8, 2022
The relationship between COVID-19 infection and intracranial hemorrhage: A systematic review
Samuel R Daly1, Anthony V Nguyen1, Yilu Zhang1
1Department of Neurosurgery, Baylor Scott and White Health, Scott and White Medical Center, Temple, TX, USA.
Insights
COVID-19 can cause neurological damage, including intracranial hemorrhage (ICH). Treatments for severe COVID-19 may increase ICH risk, highlighting the need for provider awareness and appropriate management strategies.
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- COVID-19 (Coronavirus disease 2019) poses significant risks beyond pulmonary and cardiovascular systems, including neurological complications.
- Intracranial hemorrhage (ICH) is an emerging concern in patients with COVID-19, necessitating a comprehensive understanding of its association.
Purpose of the Study:
- To systematically review and synthesize current literature on the relationship between COVID-19 infection and the occurrence of intracranial hemorrhage.
- To explore the incidence, types, risk factors, and outcomes of ICH in the context of COVID-19.
Main Methods:
- A systematic literature search was conducted on PubMed for studies investigating COVID-19 and ICH.
- Ninety-four relevant papers were selected from 295 screened articles based on predefined inclusion criteria.
Main Results:
- Literature review confirmed ICH occurrence in COVID-19 patients, including subarachnoid hemorrhage, intraparenchymal hemorrhage, and subdural hematomas.
- Hemorrhage was also observed secondary to cerebral venous thrombosis and ischemic stroke in COVID-19 patients.
- ICH in COVID-19 patients was associated with elevated morbidity and mortality, with risk factors including therapeutic anticoagulation, ECMO, and mechanical ventilation.
Conclusions:
- Neurological injury, specifically ICH, is a potential complication of COVID-19, even with treatments targeting acute respiratory distress syndrome, vasculopathy, and coagulopathy.
- Therapeutic interventions aimed at improving COVID-19 survival may inadvertently elevate the risk of developing ICH.
- Healthcare providers must be vigilant regarding potential neurological sequelae of COVID-19, employ appropriate diagnostic methods to exclude other causes of ICH, and tailor treatment regimens accordingly.
Introduction:
In addition to the deleterious effects Covid-19 has on the pulmonary and cardiovascular systems, COVID-19 can also result in damage to the nervous system. This review aims to explore current literature on the association between COVID-19 and intracranial hemorrhage (ICH).
Methods:
We conducted a systematic review of PubMed for literature published on COVID-19 and ICH. Ninety-four of 295 screened papers met inclusion criteria.
Results:
The literature addressed incidence and mortality of ICH associated with Covid-19. It also revealed cases of COVID-19 patients with subarachnoid hemorrhage, intraparenchymal hemorrhage, subdural hematomas, and hemorrhage secondary to cerebral venous thrombosis and ischemic stroke. ICH during COVID-19 infections was associated with increased morbidity and mortality. Risk factors for ICH appeared to be therapeutic anticoagulation, ECMO, and mechanical ventilation. Outcomes varied widely, depending on the severity of COVID-19 infection and neurologic injury.
Conclusion:
Although treatment for severe Covid-19 infections is often aimed at addressing acute respiratory distress syndrome, vasculopathy, and coagulopathy, neurologic injury can also occur. Evidence-based treatments that improve COVID-19 mortality may also increase risk for developing ICH. Providers should be aware of potential neurologic sequelae of COVID-19, diagnostic methods to rule out other causes of ICH, and treatment regimens.
