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Spontaneous subdural effusion in a hospitalized Covid-19 patient: Case report
Artur Eduardo Martio1, Ana Luisa Dos Santos Carregosa2, Octávio Ruschel Karam1
1Neurosurgery Department, Hospital de Clínicas de Passo Fundo, Passo Fundo, Brazil.
Abstract:
Subdural effusions (SE) have already been associated with several viruses, but there are few associations with Covid-19 reported to date, and all of them had one thing in common: the presence of superimposed bacterial rhinosinusitis. Here we describe the case of a 76-year-old male patient that was transferred to our center due to severe SARS-CoV-2 infection and developed a SE during hospital stay. He presented sensory level impairment during hospitalization, but an initial Head CT scan showed no alterations. A new CT scan performed six days later evidentiated a bilateral SE. The patient had a cardiorespiratory arrest during the night of the same day, resulting in death. Covid-19 as a direct cause of subdural effusion (positive Covid-19 PCR in subdural fluid) has never before been reported in the literature, and, unfortunately, it was not possible to rule out or confirm this phenomenon in our case due to the rapid evolution of the clinical picture. However, our case clearly differs from the literature as the patient did not show any signs of sinus disease or intracranial hypotension, and the possible causes of the effusion boil down to spontaneity and the direct action of Covid-19 in the CNS and subdural space.
Insights
This case report details a severe COVID-19 case where subdural effusion (SE) developed. Unlike prior cases, this patient lacked sinus issues, suggesting SARS-CoV-2 might directly cause SE in the central nervous system.
Area of Science:
- Neurology
- Infectious Diseases
- Critical Care Medicine
Background:
- Subdural effusions (SE) are uncommon complications associated with viral infections.
- Existing literature links SE in viral infections predominantly to cases with superimposed bacterial rhinosinusitis.
Observation:
- A 76-year-old male with severe SARS-CoV-2 infection developed bilateral SE during hospitalization.
- The patient presented with sensory level impairment, initially without CT scan abnormalities.
- A subsequent CT scan revealed bilateral SE; the patient experienced cardiorespiratory arrest and expired.
Findings:
- This case presents a potential direct association between COVID-19 and SE, distinct from previously reported cases.
- The patient exhibited no signs of sinus disease or intracranial hypotension, differentiating it from prior literature.
- COVID-19 PCR in subdural fluid was not feasible to confirm direct causation due to rapid clinical deterioration.
Implications:
- This case highlights the potential for SARS-CoV-2 to directly impact the central nervous system and subdural space, leading to SE.
- Further research is needed to elucidate the mechanisms by which COVID-19 may cause SE in the absence of bacterial coinfection.
- Understanding these mechanisms could inform diagnostic and therapeutic strategies for neurological complications of COVID-19.
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