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Fulminant Extra- And Intracranial Arteriovenous Thrombosis And Non-aneurysmal Subarachnoid Hemorrhage Following

Sunil V Furtado1, Nishchit Hegde1, Vinay M D Prabhu2

  • 1Department of Neurosurgery, Ramaiah Medical College and Hospital, Bangalore, India.

Acta Neurologica Taiwanica
|May 17, 2023
PubMed

Insights

COVID-19 can cause severe arteriovenous inflammation leading to extensive cerebral arteriovenous thrombosis and subarachnoid hemorrhage (SAH). This rare complication following infection carries a poor prognosis, highlighting the need for high suspicion.

Area of Science:

  • Neurology
  • Vascular Medicine
  • Infectious Diseases

Background:

  • Coronavirus disease 2019 (COVID-19) is linked to an increased risk of cerebrovascular events, including stroke and hemorrhage.
  • Previous reports suggest a potential association between COVID-19 infection and thrombotic events.

Observation:

  • This case report details a rare instance of fulminant panvascular arteriovenous thrombosis with subarachnoid hemorrhage (SAH) in a patient post-COVID-19 infection.
  • The extensive extra- and intra-cranial thrombosis presented as a fatal, non-aneurysmal subarachnoid hemorrhage.
  • Arteriovenous inflammation leading to vasculitis was identified as the likely cause of arterial rupture.

Findings:

  • COVID-19 infection can precipitate severe coagulopathy.
  • Extensive non-aneurysmal, non-hemispheric SAH and malignant intracranial hypertension were observed.
  • The patient's outcome was poor, consistent with previous reports on non-aneurysmal SAH in COVID-19 patients.

Implications:

  • Clinicians should maintain a high index of suspicion for COVID-19-induced coagulopathy presenting with severe intracranial hemorrhage.
  • Early recognition and management of such vascular complications are crucial for patients with COVID-19.
  • This case underscores the diverse and severe neurological manifestations of COVID-19.
Abstract

Keywords:
arterial thrombosis; basilar artery; COVID-19; non-aneurysmal SAH; superior sagittal sinus.

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