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Updated: Aug 18, 2025
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Primary spontaneous intracerebral hemorrhage in COVID-19 patients: differences among presentation patterns - A
Gustavo Parra-Romero1, José L Navarro-Olvera1,2, Jesús Q Beltrán-Mendoza1,2
1Department of Neurosurgery, Hospital General de Mexico, Mexico City.
Insights
COVID-19 can cause hemorrhagic stroke (HS) with distinct presentation patterns. Pulmonary symptoms often precede HS, while neurological symptoms are linked to hypertension and lower hemoglobin.
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Hemorrhagic stroke (HS) is an increasingly recognized complication of COVID-19.
- Understanding distinct HS presentation patterns associated with SARS-CoV-2 infection is crucial for timely diagnosis and management.
Approach:
- Systematic literature review following PRISMA guidelines of PubMed-reported cases.
- Inclusion of a hospital's own cohort of HS cases linked to SARS-CoV-2.
- Stratification of patients based on initial presentation: neurological vs. pulmonary symptoms.
Key Points:
- Pulmonary symptom onset preceded HS in 68.6% of cases, with a median interval of 15.6 days.
- Pulmonary presentation was associated with anticoagulant use, multifocal imaging, and elevated D-dimer, ferritin, and LDH.
- Neurological presentation was associated with hypertension and lower hemoglobin levels.
Conclusions:
- Hemorrhagic stroke associated with COVID-19 presents with at least two distinct clinical patterns.
- These patterns exhibit unique characteristics, suggesting different underlying pathophysiological mechanisms.
Objective:
The objective of this study was to determine if there are differences between the presentation patterns of hemorrhagic stroke (HS) associated to COVID-19.
Methods:
It was performed a systematic search based on PRISMA guidelines of the cases reported in PUBMED of HS associated to SARS-CoV-2 infection and we added to this sample cases from our own hospital cohort. Patients in the database were separated by groups according to presentation symptoms: if they debuted with neurological symptoms or debuted with pulmonary symptoms.
Results:
Seventy cases were included in the study. Patients that debuted with pulmonary symptoms accounted for 68.6% of the cases with an interval between the development of symptoms and the presentation of HS of 15.6 days. We found that the use of anticoagulants during hospitalization, multifocal image pattern, and the elevation of D-dimer, Ferritin, and lactate dehydrogenase levels were significantly associated with the group of pulmonary presentation, whereas the presence of hypertension during hospitalization, and a lower hemoglobin level was associated with the group of neurologic symptoms.
Conclusion:
Although HS associated with COVID-19 is a clinical entity with increasing evidence, it is necessary to establish that there are two forms of presentation with their own characteristics.
