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A Non-traumatic Non-aneurysmal Subarachnoid Hemorrhage in a Mild COVID-19 Infection: A Case Report
Mohammad Abu-Abaa1, Ali Abdulsahib2, Ghassan Al-Qaysi1
1Internal Medicine, Internal Medicine Residency Program, Capital Health Regional Medical Center, Trenton, USA.
Insights
Mild coronavirus disease (COVID-19) infection can be linked to serious neurological complications like subarachnoid hemorrhage. Prompt investigation of headaches in COVID-19 patients is crucial for early detection of intracranial bleeding.
Area of Science:
- Neurology
- Infectious Diseases
- Neurocritical Care
Background:
- Coronavirus disease (COVID-19) has been associated with various neurological complications, including intracranial hemorrhages like subarachnoid hemorrhage (SAH) and intraparenchymal hemorrhage (IPH).
- While severe COVID-19 cases are more frequently linked to neurological events, the potential for such complications in milder infections warrants attention.
Observation:
- A 38-year-old male with mild COVID-19 infection, confirmed 10 days prior, presented with worsening occipital headache during hospitalization for alcoholic hepatitis.
- Despite intact neurological examination and no known risk factors (trauma, hypertension, drug use, family history of aneurysm), investigations revealed a small, right-sided, posterior subarachnoid hemorrhage.
- Cerebral angiography excluded an aneurysm, and no coagulopathy was detected.
Findings:
- The case highlights a potential association between mild COVID-19 infection and the occurrence of subarachnoid hemorrhage.
- Headache, a common symptom, may serve as an early indicator of intracranial bleeding in the context of COVID-19.
Implications:
- This case underscores the importance of a thorough neurological evaluation, including neuroimaging, for patients experiencing headaches during or following even mild COVID-19 infections.
- Early investigation of headaches in COVID-19 patients is critical for identifying and managing potentially life-threatening intracranial hemorrhages.
- Further research is needed to elucidate the mechanisms linking mild COVID-19 to cerebrovascular events.
Abstract:
Both subarachnoid hemorrhage and intraparenchymal hemorrhage have been reported in patients with coronavirus disease 2019 (COVID-19) infection. We report a 38-year-old male patient who was initially admitted for alcoholic hepatitis and had a mild COVID-19 infection that was confirmed 10 days prior to presentation. During his hospitalization, he reported worsening of his occipital headache that started when he tested positive for COVID-19. Neurological examination was intact and no history of trauma, hypertension, illicit drug use, or family history of brain aneurysm was reported. Investigating his worsening headache revealed a tiny, right-sided, posterior subarachnoid hemorrhage. No coagulopathy was evident. No aneurysm was seen on the cerebral angiogram. The patient was managed conservatively. This case raises the point of the importance of investigating headaches even in mild COVID-19 infection, as it may herald intracranial bleeding.
